Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $64.57 / $134.90	Facility	26	$44.67	$64.57	$134.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $158.49 / $316.23	Professional		$120.23	$158.49	$316.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $51.29 / $123.03	Professional	26	$39.81	$51.29	$123.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $107.15 / $186.21	Professional	TC	$79.43	$107.15	$186.21
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $54.95 / $63.10	Professional	26	$54.95	$54.95	$63.10
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $208.93 / $346.74	Professional		$154.88	$208.93	$346.74
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $63.10 / $109.65	Professional	26	$45.71	$63.10	$109.65
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $144.54 / $239.88	Professional	TC	$97.72	$144.54	$239.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $194.98 / $309.03	Professional		$131.83	$194.98	$309.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $60.26 / $91.20	Professional	26	$43.65	$60.26	$91.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $125.89 / $218.78	Professional	TC	$89.13	$125.89	$218.78
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $186.21 / $288.40	Professional		$123.03	$186.21	$288.40
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $60.26 / $87.10	Professional	26	$43.65	$60.26	$87.10
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $125.89 / $194.98	Professional	TC	$87.10	$125.89	$194.98
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $44.67	Professional		$32.36	$33.11	$44.67
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $295.12 / $295.12 / $295.12	Facility	26	$295.12	$295.12	$295.12
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $165.96 / $302.00	Professional		$134.90	$165.96	$302.00
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $54.95 / $97.72	Professional	26	$43.65	$54.95	$97.72
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $112.20 / $204.17	Professional	TC	$91.20	$112.20	$204.17
United Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $165.96 / $275.42	Professional		$117.49	$165.96	$275.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $52.48 / $85.11	Professional	26	$38.90	$52.48	$85.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $109.65 / $186.21	Professional	TC	$79.43	$109.65	$186.21