Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $77.62 / $199.53	Facility	26	$58.88	$77.62	$199.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $398.11 / $870.96	Professional		$234.42	$398.11	$870.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $102.33 / $181.97	Professional	26	$57.54	$102.33	$181.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $302.00 / $660.69	Professional	TC	$173.78	$302.00	$660.69
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $66.07 / $66.07	Professional	26	$66.07	$66.07	$66.07
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $416.87 / $707.95	Professional		$302.00	$416.87	$707.95
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $74.13 / $125.89	Professional	26	$58.88	$74.13	$125.89
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $338.84 / $575.44	Professional	TC	$229.09	$338.84	$575.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.80 / $64.57 / $91.20	Facility	26	$13.80	$64.57	$91.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $436.52 / $831.76	Professional		$208.93	$436.52	$831.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $77.62 / $147.91	Professional	26	$48.98	$77.62	$147.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $338.84 / $707.95	Professional	TC	$169.82	$338.84	$707.95
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $13.80 / $64.57 / $91.20	Facility	26	$13.80	$64.57	$91.20
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $426.58 / $831.76	Professional		$208.93	$426.58	$831.76
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $75.86 / $151.36	Professional	26	$48.98	$75.86	$151.36
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $331.13 / $741.31	Professional	TC	$162.18	$331.13	$741.31
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $177.83	Professional		$32.36	$33.11	$177.83
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $426.58 / $426.58 / $426.58	Facility	26	$426.58	$426.58	$426.58
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $169.82 / $398.11	Professional		$134.90	$169.82	$398.11
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $67.61 / $120.23	Professional	26	$53.70	$67.61	$120.23
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $102.33 / $323.59	Professional	TC	$81.28	$102.33	$323.59
United Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $323.59 / $645.65	Professional		$218.78	$323.59	$645.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $61.66 / $114.82	Professional	26	$46.77	$61.66	$114.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $239.88 / $549.54	Professional	TC	$162.18	$239.88	$549.54