Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.88 / $45.71 / $64.57	Facility	26	$33.88	$45.71	$64.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $338.84 / $794.33	Professional		$269.15	$338.84	$794.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $52.48 / $120.23	Professional	26	$32.36	$52.48	$120.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $302.00 / $691.83	Professional	TC	$234.42	$302.00	$691.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $213.80 / $213.80	Professional		$213.80	$213.80	$213.80
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $28.18 / $60.26	Professional	26	$25.70	$28.18	$60.26
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $389.05 / $616.60	Professional		$302.00	$389.05	$616.60
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $42.66 / $66.07	Professional	26	$33.88	$42.66	$66.07
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $346.74 / $549.54	Professional	TC	$269.15	$346.74	$549.54
CareSource Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $263.03 / $588.84	Professional		$32.36	$263.03	$588.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $416.87 / $794.33	Professional		$269.15	$416.87	$794.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $45.71 / $85.11	Professional	26	$33.11	$45.71	$85.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $363.08 / $691.83	Professional	TC	$239.88	$363.08	$691.83
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $416.87 / $794.33	Professional		$269.15	$416.87	$794.33
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $51.29 / $93.33	Professional	26	$33.88	$51.29	$93.33
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $363.08 / $691.83	Professional	TC	$251.19	$363.08	$691.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $32.36 / $33.11	Professional		$32.36	$32.36	$33.11
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $489.78 / $489.78 / $489.78	Facility	26	$489.78	$489.78	$489.78
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $416.87 / $602.56	Professional		$288.40	$416.87	$602.56
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $47.86 / $75.86	Professional	26	$36.31	$47.86	$75.86
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $363.08 / $537.03	Professional	TC	$251.19	$363.08	$537.03
United Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $346.74 / $602.56	Professional		$263.03	$346.74	$602.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $39.81 / $69.18	Professional	26	$28.84	$39.81	$69.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $309.03 / $537.03	Professional	TC	$229.09	$309.03	$537.03