Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.36 / $46.77 / $102.33	Facility	26	$32.36	$46.77	$102.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $104.71 / $239.88	Professional		$69.18	$104.71	$239.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $36.31 / $213.80	Professional	26	$30.90	$36.31	$213.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $67.61 / $107.15	Professional	TC	$34.67	$67.61	$107.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $93.33 / $208.93	Professional		$93.33	$93.33	$208.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $33.11 / $51.29	Professional	26	$31.62	$33.11	$51.29
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $66.07 / $131.83	Professional		$50.12	$66.07	$131.83
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $40.74 / $66.07	Professional	26	$30.20	$40.74	$66.07
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $13.80 / $19.95 / $75.86	Professional	TC	$13.80	$19.95	$75.86
CareSource Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $75.86 / $134.90	Professional		$37.15	$75.86	$134.90
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.13 / $38.02 / $54.95	Facility	26	$8.13	$38.02	$54.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $114.82 / $223.87	Professional		$72.44	$114.82	$223.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $45.71 / $87.10	Professional	26	$31.62	$45.71	$87.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $69.18 / $138.04	Professional	TC	$25.70	$69.18	$138.04
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $8.13 / $38.02 / $54.95	Facility	26	$8.13	$38.02	$54.95
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $109.65 / $194.98	Professional		$67.61	$109.65	$194.98
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $45.71 / $83.18	Professional	26	$29.51	$45.71	$83.18
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $69.18 / $128.82	Professional	TC	$29.51	$69.18	$128.82
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $158.49 / $158.49 / $158.49	Facility	26	$158.49	$158.49	$158.49
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $114.82 / $229.09	Professional		$97.72	$114.82	$229.09
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $40.74 / $77.62	Professional	26	$34.67	$40.74	$77.62
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $75.86 / $154.88	Professional	TC	$46.77	$75.86	$154.88
United Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $95.50 / $177.83	Professional		$57.54	$95.50	$177.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $39.81 / $70.79	Professional	26	$29.51	$39.81	$70.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $60.26 / $109.65	Professional	TC	$24.55	$60.26	$109.65