Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $219.12 / $623.51 / $3,847.00	Facility		$219.12	$623.51	$3,847.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $140.76 / $209.31 / $467.63	Facility	54	$140.76	$209.31	$467.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $163.97 / $208.58 / $425.60	Professional		$163.97	$208.58	$425.60
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $126.23 / $149.40 / $259.98	Professional	54	$126.23	$149.40	$259.98
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $100.09 / $196.22 / $304.14	Professional		$100.09	$196.22	$304.14
Ambetter Facility/Professional Professional Modifier 54 Low / Median / High Price $263.79 / $263.79 / $310.35	Professional	54	$263.79	$263.79	$310.35
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $814.00 / $1,927.00 / $3,943.00	Facility		$814.00	$1,927.00	$3,943.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $106.34 / $162.63 / $293.70	Professional		$106.34	$162.63	$293.70
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $235.46 / $235.46 / $235.46	Professional		$235.46	$235.46	$235.46
CareSource Facility/Professional Facility Modifier Low / Median / High Price $172.72 / $188.42 / $274.37	Facility		$172.72	$188.42	$274.37
CareSource Facility/Professional Professional Modifier Low / Median / High Price $147.66 / $215.84 / $274.70	Professional		$147.66	$215.84	$274.70
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 $184.63 / $255.09 / $367.49	Professional		$184.63	$255.09	$367.49
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $149.56 / $313.79 / $367.38	Facility		$149.56	$313.79	$367.38
Medical Mutual of Ohio Facility/Professional Facility Modifier 54 Low / Median / High Price $230.60 / $230.60 / $230.60	Facility	54	$230.60	$230.60	$230.60
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $192.97 / $264.89 / $365.16	Professional		$192.97	$264.89	$365.16
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.67 / $138.86 / $243.05	Professional		$30.67	$138.86	$243.05
United Facility/Professional Facility Modifier Low / Median / High Price $444.00 / $965.00 / $2,914.00	Facility		$444.00	$965.00	$2,914.00
United Facility/Professional Professional Modifier Low / Median / High Price $151.28 / $232.62 / $386.15	Professional		$151.28	$232.62	$386.15