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 / $208.93	Facility	26	$60.26	$81.28	$208.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $275.42 / $660.69	Professional		$190.55	$275.42	$660.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $69.18 / $151.36	Professional	26	$52.48	$69.18	$151.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $199.53 / $501.19	Professional	TC	$134.90	$199.53	$501.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $204.17 / $204.17	Professional		$204.17	$204.17	$204.17
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $56.23 / $100.00	Professional	26	$45.71	$56.23	$100.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $323.59 / $512.86	Professional		$251.19	$323.59	$512.86
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $81.28 / $131.83	Professional	26	$63.10	$81.28	$131.83
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $234.42 / $398.11	Professional	TC	$181.97	$234.42	$398.11
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 $190.55 / $323.59 / $645.65	Professional		$190.55	$323.59	$645.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $81.28 / $134.90	Professional	26	$51.29	$81.28	$134.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $239.88 / $512.86	Professional	TC	$134.90	$239.88	$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 $186.21 / $316.23 / $691.83	Professional		$186.21	$316.23	$691.83
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $81.28 / $144.54	Professional	26	$52.48	$81.28	$144.54
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $223.87 / $562.34	Professional	TC	$131.83	$223.87	$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 $123.03 / $162.18 / $380.19	Professional		$123.03	$162.18	$380.19
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $74.13 / $125.89	Professional	26	$57.54	$74.13	$125.89
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $87.10 / $245.47	Professional	TC	$66.07	$87.10	$245.47
United Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $281.84 / $512.86	Professional		$190.55	$281.84	$512.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $66.07 / $120.23	Professional	26	$51.29	$66.07	$120.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $199.53 / $380.19	Professional	TC	$134.90	$199.53	$380.19