Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $141.25 / $389.05	Facility	26	$107.15	$141.25	$389.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $691.83 / $954.99 / $2,570.40	Professional		$691.83	$954.99	$2,570.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $186.21 / $602.56	Professional	26	$107.15	$186.21	$602.56
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $275.42 / $891.25 / $2,344.23	Professional	52	$275.42	$891.25	$2,344.23
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $398.11 / $426.58 / $676.08	Professional	53	$398.11	$426.58	$676.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $562.34 / $741.31 / $1,412.54	Professional	TC	$562.34	$741.31	$1,412.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $645.65 / $1,258.93	Professional		$512.86	$645.65	$1,258.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $125.89 / $223.87	Professional	26	$89.13	$125.89	$223.87
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $389.05 / $389.05 / $389.05	Professional	52	$389.05	$389.05	$389.05
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $691.83 / $691.83 / $691.83	Professional	TC	$691.83	$691.83	$691.83
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $794.33 / $1,071.52 / $1,819.70	Professional		$794.33	$1,071.52	$1,819.70
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $147.91 / $204.17 / $331.13	Professional	26	$147.91	$204.17	$331.13
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $660.69 / $870.96 / $1,445.44	Professional	TC	$660.69	$870.96	$1,445.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $125.89 / $177.83	Facility	26	$26.92	$125.89	$177.83
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $36.31 / $181.97 / $213.80	Facility	53	$36.31	$181.97	$213.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $691.83 / $1,023.29 / $1,778.28	Professional		$691.83	$1,023.29	$1,778.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $186.21 / $338.84	Professional	26	$109.65	$186.21	$338.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $575.44 / $831.76 / $1,445.44	Professional	TC	$575.44	$831.76	$1,445.44
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $125.89 / $177.83	Facility	26	$26.92	$125.89	$177.83
Medical Mutual of Ohio Facility/Professional Facility Modifier 53 Low / Median / High Price $36.31 / $173.78 / $208.93	Facility	53	$36.31	$173.78	$208.93
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $977.24 / $1,659.59	Professional		$660.69	$977.24	$1,659.59
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $177.83 / $323.59	Professional	26	$107.15	$177.83	$323.59
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $549.54 / $794.33 / $1,288.25	Professional	TC	$549.54	$794.33	$1,288.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $645.65	Professional		$32.36	$33.11	$645.65
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $1,122.02 / $1,122.02 / $1,122.02	Facility	26	$1,122.02	$1,122.02	$1,122.02
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $776.25 / $954.99 / $1,737.80	Professional		$776.25	$954.99	$1,737.80
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $151.36 / $302.00	Professional	26	$120.23	$151.36	$302.00
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $660.69 / $812.83 / $1,445.44	Professional	TC	$660.69	$812.83	$1,445.44
United Facility/Professional Professional Modifier Low / Median / High Price $724.44 / $977.24 / $1,737.80	Professional		$724.44	$977.24	$1,737.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $177.83 / $302.00	Professional	26	$114.82	$177.83	$302.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $616.60 / $794.33 / $1,445.44	Professional	TC	$616.60	$794.33	$1,445.44