Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $114.82 / $295.12	Facility	26	$89.13	$114.82	$295.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $446.68 / $1,096.48	Professional		$275.42	$446.68	$1,096.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $141.25 / $316.23	Professional	26	$85.11	$141.25	$316.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $309.03 / $691.83	Professional	TC	$190.55	$309.03	$691.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $83.18 / $151.36	Professional	26	$75.86	$83.18	$151.36
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $467.74 / $758.58	Professional		$346.74	$467.74	$758.58
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $114.82 / $186.21	Professional	26	$89.13	$114.82	$186.21
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $338.84 / $588.84	Professional	TC	$234.42	$338.84	$588.84
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $97.72 / $138.04	Facility	26	$20.89	$97.72	$138.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $457.09 / $933.25	Professional		$263.03	$457.09	$933.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $114.82 / $190.55	Professional	26	$72.44	$114.82	$190.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $316.23 / $741.31	Professional	TC	$181.97	$316.23	$741.31
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $97.72 / $138.04	Facility	26	$20.89	$97.72	$138.04
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $457.09 / $977.24	Professional		$251.19	$457.09	$977.24
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $114.82 / $208.93	Professional	26	$75.86	$114.82	$208.93
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $316.23 / $794.33	Professional	TC	$177.83	$316.23	$794.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $186.21	Professional		$32.36	$33.11	$186.21
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 $169.82 / $213.80 / $489.78	Professional		$169.82	$213.80	$489.78
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $100.00 / $177.83	Professional	26	$79.43	$100.00	$177.83
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $112.20 / $338.84	Professional	TC	$89.13	$112.20	$338.84
United Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $380.19 / $741.31	Professional		$257.04	$380.19	$741.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $93.33 / $173.78	Professional	26	$70.79	$93.33	$173.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $257.04 / $549.54	Professional	TC	$177.83	$257.04	$549.54