Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $57.54 / $120.23	Facility	26	$38.02	$57.54	$120.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $234.42 / $562.34	Professional		$177.83	$234.42	$562.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $47.86 / $107.15	Professional	26	$32.36	$47.86	$107.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $181.97 / $416.87	Professional	TC	$144.54	$181.97	$416.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $151.36 / $257.04	Professional		$134.90	$151.36	$257.04
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $38.02 / $66.07	Professional	26	$27.54	$38.02	$66.07
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $208.93 / $346.74	Professional		$165.96	$208.93	$346.74
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $30.90 / $52.48	Professional	26	$23.44	$30.90	$52.48
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $177.83 / $295.12	Professional	TC	$134.90	$177.83	$295.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $251.19 / $416.87	Professional		$181.97	$251.19	$416.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $40.74 / $72.44	Professional	26	$26.30	$40.74	$72.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $213.80 / $380.19	Professional	TC	$147.91	$213.80	$380.19
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $245.47 / $407.38	Professional		$177.83	$245.47	$407.38
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $39.81 / $72.44	Professional	26	$26.30	$39.81	$72.44
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $208.93 / $371.54	Professional	TC	$144.54	$208.93	$371.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $32.36 / $33.11	Professional		$32.36	$32.36	$33.11
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 $194.98 / $239.88 / $426.58	Professional		$194.98	$239.88	$426.58
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $45.71 / $85.11	Professional	26	$38.02	$45.71	$85.11
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $190.55 / $346.74	Professional	TC	$154.88	$190.55	$346.74
United Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $229.09 / $416.87	Professional		$165.96	$229.09	$416.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $40.74 / $83.18	Professional	26	$22.39	$40.74	$83.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $194.98 / $338.84	Professional	TC	$134.90	$194.98	$338.84