Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.63 / $54.59 / $117.13	Facility	26	$30.63	$54.59	$117.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.84 / $78.68 / $134.26	Professional		$67.84	$78.68	$134.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.62 / $30.63 / $59.99	Professional	26	$27.62	$30.63	$59.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.09 / $45.64 / $80.31	Professional	TC	$38.09	$45.64	$80.31
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $83.04 / $97.81 / $170.44	Professional		$83.04	$97.81	$170.44
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $34.76 / $42.60 / $73.11	Professional	26	$34.76	$42.60	$73.11
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $122.46 / $146.71 / $255.67	Professional	50	$122.46	$146.71	$255.67
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $46.07 / $54.02 / $95.60	Professional	TC	$46.07	$54.02	$95.60
CareSource Facility/Professional Professional Modifier Low / Median / High Price $33.07 / $41.21 / $84.40	Professional		$33.07	$41.21	$84.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.27 / $104.58 / $166.85	Professional		$74.27	$104.58	$166.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $42.71 / $69.13	Professional	26	$30.20	$42.71	$69.13
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $126.81 / $126.81 / $145.44	Professional	50	$126.81	$126.81	$145.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.21 / $63.46 / $105.71	Professional	TC	$41.21	$63.46	$105.71
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $74.27 / $101.97 / $166.85	Professional		$74.27	$101.97	$166.85
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $31.56 / $42.71 / $70.75	Professional	26	$31.56	$42.71	$70.75
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $42.98 / $60.00 / $104.76	Professional	TC	$42.98	$60.00	$104.76
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.56 / $48.62 / $131.63	Professional		$29.56	$48.62	$131.63
United Facility/Professional Professional Modifier Low / Median / High Price $72.56 / $102.50 / $161.77	Professional		$72.56	$102.50	$161.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.45 / $39.13 / $65.02	Professional	26	$29.45	$39.13	$65.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.50 / $64.59 / $101.21	Professional	TC	$44.50	$64.59	$101.21