Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.12 / $69.18 / $181.97	Facility	26	$50.12	$69.18	$181.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $213.80 / $616.60	Professional		$177.83	$213.80	$616.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $52.48 / $131.83	Professional	26	$42.66	$52.48	$131.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $158.49 / $309.03	Professional	TC	$131.83	$158.49	$309.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $60.26 / $93.33	Professional	26	$48.98	$60.26	$93.33
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $275.42 / $457.09	Professional		$208.93	$275.42	$457.09
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $69.18 / $112.20	Professional	26	$54.95	$69.18	$112.20
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $208.93 / $338.84	Professional	TC	$154.88	$208.93	$338.84
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.59 / $58.88 / $85.11	Facility	26	$12.59	$58.88	$85.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $288.40 / $537.03	Professional		$186.21	$288.40	$537.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $70.79 / $120.23	Professional	26	$44.67	$70.79	$120.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $213.80 / $371.54	Professional	TC	$138.04	$213.80	$371.54
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $12.59 / $58.88 / $85.11	Facility	26	$12.59	$58.88	$85.11
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $281.84 / $575.44	Professional		$181.97	$281.84	$575.44
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $69.18 / $131.83	Professional	26	$45.71	$69.18	$131.83
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $204.17 / $380.19	Professional	TC	$131.83	$204.17	$380.19
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $134.90	Professional		$32.36	$33.11	$134.90
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $295.12 / $295.12 / $295.12	Facility	26	$295.12	$295.12	$295.12
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $204.17 / $426.58	Professional		$125.89	$204.17	$426.58
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $60.26 / $109.65	Professional	26	$48.98	$60.26	$109.65
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $87.10 / $158.49	Professional	TC	$70.79	$87.10	$158.49
United Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $234.42 / $426.58	Professional		$186.21	$234.42	$426.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $57.54 / $107.15	Professional	26	$44.67	$57.54	$107.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $177.83 / $331.13	Professional	TC	$138.04	$177.83	$331.13