Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $213.80 / $371.54	Professional		$100.00	$213.80	$371.54
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $72.44 / $72.44	Professional		$72.44	$72.44	$72.44
CareSource Facility/Professional Facility Modifier Low / Median / High Price $97.72 / $134.90 / $173.78	Facility		$97.72	$134.90	$173.78
CareSource Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $123.03 / $223.87	Professional		$97.72	$123.03	$223.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $102.33 / $123.03	Professional		$102.33	$102.33	$123.03
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $2,290.87 / $2,290.87 / $2,290.87	Facility		$2,290.87	$2,290.87	$2,290.87
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $309.03 / $309.03	Professional		$309.03	$309.03	$309.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $50.12 / $60.26	Professional		$32.36	$50.12	$60.26
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $125.89 / $138.04	Professional		$125.89	$125.89	$138.04
United Facility/Professional Facility Modifier Low / Median / High Price $371.54 / $371.54 / $371.54	Facility		$371.54	$371.54	$371.54
United Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $389.05 / $676.08	Professional		$213.80	$389.05	$676.08