Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $91.20 / $208.93	Facility	26	$61.66	$91.20	$208.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $275.42 / $660.69	Professional		$208.93	$275.42	$660.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $67.61 / $186.21	Professional	26	$52.48	$67.61	$186.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $194.98 / $467.74	Professional	TC	$151.36	$194.98	$467.74
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $158.49 / $158.49	Professional		$158.49	$158.49	$158.49
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $316.23 / $457.09	Professional		$251.19	$316.23	$457.09
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $77.62 / $107.15	Professional	26	$60.26	$77.62	$107.15
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $229.09 / $363.08	Professional	TC	$169.82	$229.09	$363.08
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $416.87 / $416.87	Professional		$416.87	$416.87	$416.87
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $117.49 / $117.49	Professional	26	$117.49	$117.49	$117.49
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $295.12 / $295.12	Professional	TC	$295.12	$295.12	$295.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $323.59 / $724.44	Professional		$199.53	$323.59	$724.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $79.43 / $141.25	Professional	26	$54.95	$79.43	$141.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $234.42 / $630.96	Professional	TC	$141.25	$234.42	$630.96
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $302.00 / $912.01	Professional		$194.98	$302.00	$912.01
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $79.43 / $128.82	Professional	26	$54.95	$79.43	$128.82
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $213.80 / $630.96	Professional	TC	$138.04	$213.80	$630.96
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $269.15 / $645.65	Professional		$213.80	$269.15	$645.65
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $75.86 / $134.90	Professional	26	$61.66	$75.86	$134.90
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $190.55 / $562.34	Professional	TC	$154.88	$190.55	$562.34
United Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $281.84 / $676.08	Professional		$190.55	$281.84	$676.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $67.61 / $112.20	Professional	26	$47.86	$67.61	$112.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $199.53 / $616.60	Professional	TC	$138.04	$199.53	$616.60