Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $117.49 / $257.04	Facility	26	$91.20	$117.49	$257.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $338.84 / $977.24	Professional		$218.78	$338.84	$977.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $114.82 / $371.54	Professional	26	$77.62	$114.82	$371.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $173.78 / $302.00	Professional	TC	$138.04	$173.78	$302.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $257.04 / $371.54	Professional		$204.17	$257.04	$371.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $81.28 / $100.00	Professional	26	$79.43	$81.28	$100.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $346.74 / $575.44	Professional		$257.04	$346.74	$575.44
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $138.04 / $223.87	Professional	26	$100.00	$138.04	$223.87
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $208.93 / $346.74	Professional	TC	$154.88	$208.93	$346.74
CareSource Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $158.49 / $288.40	Professional		$83.18	$158.49	$288.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $316.23 / $489.78	Professional		$223.87	$316.23	$489.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $117.49 / $177.83	Professional	26	$83.18	$117.49	$177.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $194.98 / $302.00	Professional	TC	$144.54	$194.98	$302.00
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $309.03 / $478.63	Professional		$218.78	$309.03	$478.63
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $117.49 / $173.78	Professional	26	$83.18	$117.49	$173.78
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $194.98 / $295.12	Professional	TC	$141.25	$194.98	$295.12
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $208.93	Professional		$32.36	$33.11	$208.93
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $676.08 / $676.08 / $676.08	Facility	26	$676.08	$676.08	$676.08
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $281.84 / $512.86	Professional		$229.09	$281.84	$512.86
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $102.33 / $186.21	Professional	26	$83.18	$102.33	$186.21
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $181.97 / $323.59	Professional	TC	$144.54	$181.97	$323.59
United Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $275.42 / $446.68	Professional		$204.17	$275.42	$446.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $102.33 / $165.96	Professional	26	$74.13	$102.33	$165.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $169.82 / $275.42	Professional	TC	$128.82	$169.82	$275.42