Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $120.23 / $295.12	Facility	26	$89.13	$120.23	$295.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $478.63 / $1,047.13	Professional		$338.84	$478.63	$1,047.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $125.89 / $288.40	Professional	26	$85.11	$125.89	$288.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $338.84 / $691.83	Professional	TC	$257.04	$338.84	$691.83
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $457.09 / $758.58	Professional		$346.74	$457.09	$758.58
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $114.82 / $190.55	Professional	26	$91.20	$114.82	$190.55
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $524.81 / $676.08 / $1,122.02	Professional	50	$524.81	$676.08	$1,122.02
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $331.13 / $549.54	Professional	TC	$257.04	$331.13	$549.54
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 $316.23 / $524.81 / $977.24	Professional		$316.23	$524.81	$977.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $117.49 / $199.53	Professional	26	$72.44	$117.49	$199.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $398.11 / $758.58	Professional	TC	$245.47	$398.11	$758.58
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 $309.03 / $524.81 / $1,000.00	Professional		$309.03	$524.81	$1,000.00
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $114.82 / $208.93	Professional	26	$74.13	$114.82	$208.93
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $380.19 / $776.25	Professional	TC	$239.88	$380.19	$776.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $263.03	Professional		$32.36	$33.11	$263.03
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $257.04 / $478.63	Professional		$204.17	$257.04	$478.63
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $102.33 / $177.83	Professional	26	$81.28	$102.33	$177.83
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $154.88 / $346.74	Professional	TC	$123.03	$154.88	$346.74
United Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $446.68 / $758.58	Professional		$316.23	$446.68	$758.58
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 $239.88 / $338.84 / $588.84	Professional	TC	$239.88	$338.84	$588.84