Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $138.04 / $354.81	Facility	26	$104.71	$138.04	$354.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $416.87 / $2,570.40	Professional		$323.59	$416.87	$2,570.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $123.03 / $288.40	Professional	26	$100.00	$123.03	$288.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $269.15 / $478.63	Professional	TC	$229.09	$269.15	$478.63
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $346.74 / $616.60	Professional		$281.84	$346.74	$616.60
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $125.89 / $223.87	Professional	26	$102.33	$125.89	$223.87
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $223.87 / $389.05	Professional	TC	$177.83	$223.87	$389.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $426.58 / $660.69	Professional		$316.23	$426.58	$660.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $151.36 / $229.09	Professional	26	$104.71	$151.36	$229.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $295.12 / $446.68	Professional	TC	$204.17	$295.12	$446.68
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $426.58 / $660.69	Professional		$316.23	$426.58	$660.69
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $151.36 / $229.09	Professional	26	$104.71	$151.36	$229.09
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $295.12 / $446.68	Professional	TC	$213.80	$295.12	$446.68
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $32.36 / $33.11	Professional		$32.36	$32.36	$33.11
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $851.14	Facility	26	$100.00	$100.00	$851.14
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $380.19 / $724.44	Professional		$323.59	$380.19	$724.44
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $125.89 / $239.88	Professional	26	$109.65	$125.89	$239.88
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $251.19 / $478.63	Professional	TC	$213.80	$251.19	$478.63
United Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $371.54 / $630.96	Professional		$288.40	$371.54	$630.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $128.82 / $204.17	Professional	26	$95.50	$128.82	$204.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $245.47 / $416.87	Professional	TC	$181.97	$245.47	$416.87