Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.66 / $72.44 / $128.82	Facility	26	$42.66	$72.44	$128.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $95.50 / $204.17	Professional		$75.86	$95.50	$204.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $51.29 / $125.89	Professional	26	$38.90	$51.29	$125.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $44.67 / $75.86	Professional	TC	$26.30	$44.67	$75.86
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $83.18 / $83.18	Professional		$83.18	$83.18	$83.18
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $95.50 / $162.18	Professional		$72.44	$95.50	$162.18
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $61.66 / $104.71	Professional	26	$45.71	$61.66	$104.71
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $33.88 / $60.26	Professional	TC	$24.55	$33.88	$60.26
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $45.71 / $66.07	Facility	26	$10.00	$45.71	$66.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $102.33 / $173.78	Professional		$72.44	$102.33	$173.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $60.26 / $107.15	Professional	26	$39.81	$60.26	$107.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $44.67 / $83.18	Professional	TC	$27.54	$44.67	$83.18
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $45.71 / $66.07	Facility	26	$10.00	$45.71	$66.07
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $100.00 / $162.18	Professional		$67.61	$100.00	$162.18
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $58.88 / $93.33	Professional	26	$39.81	$58.88	$93.33
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $43.65 / $79.43	Professional	TC	$26.92	$43.65	$79.43
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $51.29	Professional		$32.36	$33.11	$51.29
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $45.71 / $45.71 / $45.71	Facility	26	$45.71	$45.71	$45.71
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $95.50 / $158.49	Professional		$81.28	$95.50	$158.49
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $48.98 / $81.28	Professional	26	$41.69	$48.98	$81.28
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $46.77 / $75.86	Professional	TC	$37.15	$46.77	$75.86
United Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $83.18 / $151.36	Professional		$60.26	$83.18	$151.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $50.12 / $87.10	Professional	26	$36.31	$50.12	$87.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $33.88 / $64.57	Professional	TC	$22.39	$33.88	$64.57