Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $122.45 / $194.25 / $378.06	Facility	26	$122.45	$194.25	$378.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $581.88 / $734.13 / $1,328.63	Professional		$581.88	$734.13	$1,328.63
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $114.29 / $137.93 / $295.33	Professional	26	$114.29	$137.93	$295.33
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $261.00 / $329.97 / $421.37	Professional	52	$261.00	$329.97	$421.37
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $461.85 / $585.46 / $1,023.64	Professional	TC	$461.85	$585.46	$1,023.64
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $547.79 / $547.79 / $636.66	Professional		$547.79	$547.79	$636.66
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $106.53 / $148.91 / $177.55	Professional	26	$106.53	$148.91	$177.55
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $579.36 / $764.54 / $1,298.09	Professional		$579.36	$764.54	$1,298.09
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $110.90 / $143.91 / $252.47	Professional	26	$110.90	$143.91	$252.47
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $471.97 / $618.09 / $1,045.16	Professional	TC	$471.97	$618.09	$1,045.16
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $589.02 / $589.02 / $589.02	Professional		$589.02	$589.02	$589.02
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $114.55 / $114.55 / $114.55	Professional	26	$114.55	$114.55	$114.55
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $474.47 / $474.47 / $474.47	Professional	TC	$474.47	$474.47	$474.47
CareSource Facility/Professional Professional Modifier Low / Median / High Price $135.72 / $590.41 / $802.98	Professional		$135.72	$590.41	$802.98
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $139.38 / $139.38 / $139.38	Facility	26	$139.38	$139.38	$139.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $577.55 / $891.75 / $1,671.97	Professional		$577.55	$891.75	$1,671.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $114.55 / $177.56 / $336.10	Professional	26	$114.55	$177.56	$336.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $468.57 / $711.71 / $1,311.51	Professional	TC	$468.57	$711.71	$1,311.51
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $139.38 / $139.38 / $139.38	Facility	26	$139.38	$139.38	$139.38
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $482.14 / $824.63 / $1,287.78	Professional		$482.14	$824.63	$1,287.78
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $118.51 / $170.49 / $341.10	Professional	26	$118.51	$170.49	$341.10
Medical Mutual of Ohio Facility/Professional Professional Modifier 52 Low / Median / High Price $172.55 / $172.55 / $172.55	Professional	52	$172.55	$172.55	$172.55
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $468.57 / $687.98 / $1,172.90	Professional	TC	$468.57	$687.98	$1,172.90
Molina Facility/Professional Professional Modifier Low / Median / High Price $127.42 / $515.76 / $837.18	Professional		$127.42	$515.76	$837.18
United Facility/Professional Professional Modifier Low / Median / High Price $564.53 / $840.40 / $1,375.74	Professional		$564.53	$840.40	$1,375.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $113.80 / $173.99 / $289.06	Professional	26	$113.80	$173.99	$289.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $452.13 / $675.60 / $1,086.68	Professional	TC	$452.13	$675.60	$1,086.68