Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $107.15 / $181.97	Facility	26	$89.13	$107.15	$181.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $186.21 / $467.74	Professional		$131.83	$186.21	$467.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $95.50 / $288.40	Professional	26	$56.23	$95.50	$288.40
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $87.10 / $169.82	Professional	26	$75.86	$87.10	$169.82
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $338.84 / $549.54	Professional		$204.17	$338.84	$549.54
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $79.43 / $134.90	Professional	26	$57.54	$79.43	$134.90
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.91 / $107.15 / $154.88	Facility	26	$22.91	$107.15	$154.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $245.47 / $575.44	Professional		$144.54	$245.47	$575.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $97.72 / $177.83	Professional	26	$60.26	$97.72	$177.83
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $22.91 / $107.15 / $154.88	Facility	26	$22.91	$107.15	$154.88
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $234.42 / $630.96	Professional		$138.04	$234.42	$630.96
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $102.33 / $177.83	Professional	26	$61.66	$102.33	$177.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $44.67	Professional		$32.36	$33.11	$44.67
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $6,760.83 / $6,760.83 / $6,760.83	Facility	26	$6,760.83	$6,760.83	$6,760.83
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $208.93 / $371.54	Professional		$165.96	$208.93	$371.54
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $112.20 / $208.93	Professional	26	$93.33	$112.20	$208.93
United Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $213.80 / $512.86	Professional		$144.54	$213.80	$512.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $91.20 / $162.18	Professional	26	$53.70	$91.20	$162.18