Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $89.13 / $181.97	Facility	26	$66.07	$89.13	$181.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $162.18 / $407.38	Professional		$107.15	$162.18	$407.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $69.18 / $165.96	Professional	26	$51.29	$69.18	$165.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $75.86 / $309.03	Professional	TC	$50.12	$75.86	$309.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $54.95 / $117.49	Professional	26	$47.86	$54.95	$117.49
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $323.59 / $524.81	Professional		$165.96	$323.59	$524.81
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $77.62 / $123.03	Professional	26	$58.88	$77.62	$123.03
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $229.09 / $398.11	Professional	TC	$77.62	$229.09	$398.11
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.60 / $77.62 / $109.65	Facility	26	$16.60	$77.62	$109.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $194.98 / $562.34	Professional		$114.82	$194.98	$562.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $81.28 / $141.25	Professional	26	$54.95	$81.28	$141.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $104.71 / $457.09	Professional	TC	$53.70	$104.71	$457.09
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $16.60 / $77.62 / $109.65	Facility	26	$16.60	$77.62	$109.65
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $181.97 / $630.96	Professional		$109.65	$181.97	$630.96
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $81.28 / $147.91	Professional	26	$52.48	$81.28	$147.91
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $93.33 / $501.19	Professional	TC	$51.29	$93.33	$501.19
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $45.71	Professional		$32.36	$33.11	$45.71
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $3,890.45 / $3,890.45 / $3,890.45	Facility	26	$3,890.45	$3,890.45	$3,890.45
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $154.88 / $275.42	Professional		$125.89	$154.88	$275.42
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $81.28 / $151.36	Professional	26	$67.61	$81.28	$151.36
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $70.79 / $154.88	Professional	TC	$57.54	$70.79	$154.88
United Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $169.82 / $501.19	Professional		$112.20	$169.82	$501.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $69.18 / $123.03	Professional	26	$50.12	$69.18	$123.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $81.28 / $380.19	Professional	TC	$54.95	$81.28	$380.19