Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.70 / $72.44 / $104.71	Facility	26	$53.70	$72.44	$104.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $199.53 / $562.34	Professional		$144.54	$199.53	$562.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $93.33 / $208.93	Professional	26	$50.12	$93.33	$208.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $134.90 / $346.74	Professional	TC	$95.50	$134.90	$346.74
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $128.82 / $128.82	Professional		$128.82	$128.82	$128.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $52.48 / $93.33	Professional	26	$48.98	$52.48	$93.33
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $223.87 / $371.54	Professional		$181.97	$223.87	$371.54
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $75.86 / $125.89	Professional	26	$60.26	$75.86	$125.89
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $147.91 / $251.19	Professional	TC	$123.03	$147.91	$251.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $251.19 / $407.38	Professional		$158.49	$251.19	$407.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $74.13 / $138.04	Professional	26	$52.48	$74.13	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $154.88 / $281.84	Professional	TC	$102.33	$154.88	$281.84
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $239.88 / $407.38	Professional		$154.88	$239.88	$407.38
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $81.28 / $147.91	Professional	26	$53.70	$81.28	$147.91
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $154.88 / $275.42	Professional	TC	$102.33	$154.88	$275.42
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 Facility Modifier 26 Low / Median / High Price $660.69 / $660.69 / $660.69	Facility	26	$660.69	$660.69	$660.69
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $245.47 / $371.54	Professional		$177.83	$245.47	$371.54
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $81.28 / $123.03	Professional	26	$58.88	$81.28	$123.03
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $162.18 / $251.19	Professional	TC	$120.23	$162.18	$251.19
United Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $199.53 / $338.84	Professional		$144.54	$199.53	$338.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $63.10 / $114.82	Professional	26	$45.71	$63.10	$114.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $131.83 / $218.78	Professional	TC	$97.72	$131.83	$218.78