Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $62.37 / $462.00 / $958.64	Facility		$62.37	$462.00	$958.64
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.45 / $28.87 / $56.57	Facility	26	$17.45	$28.87	$56.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $60.14 / $74.44 / $153.12	Professional		$60.14	$74.44	$153.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.90 / $17.87 / $31.03	Professional	26	$15.90	$17.87	$31.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.33 / $54.36 / $129.94	Professional	TC	$43.33	$54.36	$129.94
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $73.55 / $100.45 / $170.29	Professional		$73.55	$100.45	$170.29
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.74 / $23.07 / $38.50	Professional	26	$15.74	$23.07	$38.50
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $49.43 / $78.23 / $132.19	Professional	TC	$49.43	$78.23	$132.19
CareSource Facility/Professional Facility Modifier Low / Median / High Price $17.30 / $50.96 / $80.23	Facility		$17.30	$50.96	$80.23
CareSource Facility/Professional Professional Modifier Low / Median / High Price $18.66 / $46.72 / $74.29	Professional		$18.66	$46.72	$74.29
Cigna Facility/Professional Facility Modifier Low / Median / High Price $75.31 / $75.31 / $75.31	Facility		$75.31	$75.31	$75.31
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.65 / $20.65 / $20.65	Facility	26	$20.65	$20.65	$20.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $59.43 / $99.81 / $209.19	Professional		$59.43	$99.81	$209.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.96 / $24.59 / $45.59	Professional	26	$16.96	$24.59	$45.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $42.04 / $71.43 / $179.06	Professional	TC	$42.04	$71.43	$179.06
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $75.31 / $75.31 / $936.18	Facility		$75.31	$75.31	$936.18
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $20.65 / $20.65 / $20.65	Facility	26	$20.65	$20.65	$20.65
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $55.66 / $91.69 / $202.03	Professional		$55.66	$91.69	$202.03
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $16.96 / $24.55 / $35.15	Professional	26	$16.96	$24.55	$35.15
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $42.47 / $66.03 / $165.23	Professional	TC	$42.47	$66.03	$165.23
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.36 / $50.69 / $86.03	Professional		$28.36	$50.69	$86.03
United Facility/Professional Professional Modifier Low / Median / High Price $60.09 / $97.53 / $160.96	Professional		$60.09	$97.53	$160.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.77 / $23.55 / $38.93	Professional	26	$15.77	$23.55	$38.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.39 / $74.33 / $123.79	Professional	TC	$42.39	$74.33	$123.79