Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.67 / $47.86 / $125.89	Facility	26	$34.67	$47.86	$125.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $151.36 / $371.54	Professional		$104.71	$151.36	$371.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $39.81 / $120.23	Professional	26	$28.84	$39.81	$120.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $114.82 / $263.03	Professional	TC	$93.33	$114.82	$263.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $43.65 / $61.66	Professional	26	$37.15	$43.65	$61.66
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $151.36 / $234.42	Professional		$114.82	$151.36	$234.42
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $47.86 / $75.86	Professional	26	$37.15	$47.86	$75.86
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $102.33 / $158.49	Professional	TC	$74.13	$102.33	$158.49
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $154.88 / $173.78	Professional		$154.88	$154.88	$173.78
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $39.81 / $44.67	Professional	26	$39.81	$39.81	$44.67
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $114.82 / $128.82	Professional	TC	$114.82	$114.82	$128.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $177.83 / $288.40	Professional		$123.03	$177.83	$288.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $45.71 / $72.44	Professional	26	$32.36	$45.71	$72.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $131.83 / $218.78	Professional	TC	$89.13	$131.83	$218.78
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $177.83 / $281.84	Professional		$120.23	$177.83	$281.84
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $45.71 / $75.86	Professional	26	$32.36	$45.71	$75.86
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $131.83 / $213.80	Professional	TC	$89.13	$131.83	$213.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $33.11 / $87.10	Professional		$28.84	$33.11	$87.10
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $128.82 / $128.82 / $128.82	Facility	26	$128.82	$128.82	$128.82
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $151.36 / $302.00	Professional		$85.11	$151.36	$302.00
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $42.66 / $75.86	Professional	26	$33.88	$42.66	$75.86
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $66.07 / $114.82	Professional	TC	$52.48	$66.07	$114.82
United Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $158.49 / $245.47	Professional		$112.20	$158.49	$245.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $39.81 / $63.10	Professional	26	$30.20	$39.81	$63.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $120.23 / $181.97	Professional	TC	$79.43	$120.23	$181.97