Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,023.29 / $4,073.80 / $10,715.19	Facility		$1,023.29	$4,073.80	$10,715.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $1,174.90 / $3,235.94	Professional		$741.31	$1,174.90	$3,235.94
Aetna Facility/Professional Professional Modifier AS Low / Median / High Price $69.18 / $257.04 / $645.65	Professional	AS	$69.18	$257.04	$645.65
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $676.08 / $933.25 / $1,122.02	Professional		$676.08	$933.25	$1,122.02
Ambetter Facility/Professional Professional Modifier AS Low / Median / High Price $125.89 / $125.89 / $125.89	Professional	AS	$125.89	$125.89	$125.89
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,698.24 / $3,548.13 / $15,135.61	Facility		$1,698.24	$3,548.13	$15,135.61
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $851.14 / $1,122.02 / $1,819.70	Professional		$851.14	$1,122.02	$1,819.70
Anthem BCBS Facility/Professional Professional Modifier AS Low / Median / High Price $120.23 / $154.88 / $257.04	Professional	AS	$120.23	$154.88	$257.04
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $1,148.15 / $1,148.15 / $1,148.15	Professional		$1,148.15	$1,148.15	$1,148.15
CareSource Facility/Professional Facility Modifier Low / Median / High Price $660.69 / $1,023.29 / $1,122.02	Facility		$660.69	$1,023.29	$1,122.02
CareSource Facility/Professional Professional Modifier Low / Median / High Price $1,047.13 / $1,348.96 / $2,398.83	Professional		$1,047.13	$1,348.96	$2,398.83
Cigna Facility/Professional Facility Modifier Low / Median / High Price $21,379.62 / $21,379.62 / $21,379.62	Facility		$21,379.62	$21,379.62	$21,379.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $812.83 / $1,230.27 / $1,995.26	Professional		$812.83	$1,230.27	$1,995.26
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $1,548.82 / $3,019.95 / $21,379.62	Facility		$1,548.82	$3,019.95	$21,379.62
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $794.33 / $1,230.27 / $2,041.74	Professional		$794.33	$1,230.27	$2,041.74
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $549.54	Professional		$32.36	$33.11	$549.54
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $100.00 / $4,365.16	Facility		$100.00	$100.00	$4,365.16
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $776.25 / $1,202.26 / $2,137.96	Professional		$776.25	$1,202.26	$2,137.96
United Facility/Professional Facility Modifier Low / Median / High Price $2,818.38 / $5,754.40 / $8,511.38	Facility		$2,818.38	$5,754.40	$8,511.38
United Facility/Professional Professional Modifier Low / Median / High Price $758.58 / $1,047.13 / $1,698.24	Professional		$758.58	$1,047.13	$1,698.24