Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $785.60 / $4,475.00 / $10,635.00	Facility		$785.60	$4,475.00	$10,635.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $1,571.56 / $7,342.00 / $14,090.90	Facility	50	$1,571.56	$7,342.00	$14,090.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $584.27 / $714.18 / $1,381.18	Professional		$584.27	$714.18	$1,381.18
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $1,432.62 / $4,348.17 / $5,685.00	Professional	50	$1,432.62	$4,348.17	$5,685.00
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $740.54 / $740.54 / $740.54	Professional	50	$740.54	$740.54	$740.54
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,760.00 / $3,576.00 / $14,996.00	Facility		$1,760.00	$3,576.00	$14,996.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $618.89 / $886.02 / $1,484.22	Professional		$618.89	$886.02	$1,484.22
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $928.33 / $1,329.03 / $2,226.33	Professional	50	$928.33	$1,329.03	$2,226.33
CareSource Facility/Professional Facility Modifier Low / Median / High Price $637.02 / $764.42 / $1,194.42	Facility		$637.02	$764.42	$1,194.42
CareSource Facility/Professional Professional Modifier Low / Median / High Price $852.42 / $865.72 / $1,511.12	Professional		$852.42	$865.72	$1,511.12
Cigna Facility/Professional Facility Modifier Low / Median / High Price $21,571.00 / $21,571.00 / $21,571.00	Facility		$21,571.00	$21,571.00	$21,571.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $670.58 / $990.97 / $1,491.84	Professional		$670.58	$990.97	$1,491.84
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $2,218.21 / $2,218.21 / $2,294.35	Facility		$2,218.21	$2,218.21	$2,294.35
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $698.66 / $1,006.05 / $1,560.50	Professional		$698.66	$1,006.05	$1,560.50
Molina Facility/Professional Professional Modifier Low / Median / High Price $78.92 / $622.14 / $1,046.50	Professional		$78.92	$622.14	$1,046.50
United Facility/Professional Facility Modifier Low / Median / High Price $2,233.00 / $4,383.00 / $6,522.00	Facility		$2,233.00	$4,383.00	$6,522.00
United Facility/Professional Professional Modifier Low / Median / High Price $674.34 / $1,046.16 / $1,668.49	Professional		$674.34	$1,046.16	$1,668.49