Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.26 / $81.28 / $239.88	Facility	26	$60.26	$81.28	$239.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $295.12 / $724.44	Professional		$208.93	$295.12	$724.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $77.62 / $199.53	Professional	26	$54.95	$77.62	$199.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $218.78 / $537.03	Professional	TC	$147.91	$218.78	$537.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $169.82 / $190.55	Professional		$169.82	$169.82	$190.55
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $56.23 / $70.79	Professional	26	$47.86	$56.23	$70.79
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $331.13 / $524.81	Professional		$263.03	$331.13	$524.81
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $93.33 / $147.91	Professional	26	$72.44	$93.33	$147.91
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $239.88 / $389.05	Professional	TC	$186.21	$239.88	$389.05
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $67.61 / $97.72	Facility	26	$14.45	$67.61	$97.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $363.08 / $691.83	Professional		$213.80	$363.08	$691.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $85.11 / $147.91	Professional	26	$53.70	$85.11	$147.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $251.19 / $512.86	Professional	TC	$147.91	$251.19	$512.86
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $67.61 / $97.72	Facility	26	$14.45	$67.61	$97.72
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $323.59 / $707.95	Professional		$199.53	$323.59	$707.95
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $83.18 / $162.18	Professional	26	$53.70	$83.18	$162.18
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $239.88 / $562.34	Professional	TC	$144.54	$239.88	$562.34
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $154.88	Professional		$32.36	$33.11	$154.88
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	26	$213.80	$213.80	$213.80
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $162.18 / $537.03	Professional		$128.82	$162.18	$537.03
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $70.79 / $125.89	Professional	26	$56.23	$70.79	$125.89
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $91.20 / $251.19	Professional	TC	$72.44	$91.20	$251.19
United Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $302.00 / $512.86	Professional		$199.53	$302.00	$512.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $72.44 / $123.03	Professional	26	$52.48	$72.44	$123.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $223.87 / $407.38	Professional	TC	$147.91	$223.87	$407.38