Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $3,162.28 / $12,589.25 / $30,902.95	Facility		$3,162.28	$12,589.25	$30,902.95
Aetna Facility/Professional Facility Modifier 22 Low / Median / High Price $22,387.21 / $22,387.21 / $22,387.21	Facility	22	$22,387.21	$22,387.21	$22,387.21
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $12,882.50 / $12,882.50 / $12,882.50	Facility	50	$12,882.50	$12,882.50	$12,882.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,122.02 / $1,995.26 / $4,897.79	Professional		$1,122.02	$1,995.26	$4,897.79
Aetna Facility/Professional Professional Modifier AS Low / Median / High Price $162.18 / $316.23 / $724.44	Professional	AS	$162.18	$316.23	$724.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $1,122.02 / $2,290.87	Professional		$154.88	$1,122.02	$2,290.87
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,235.94 / $22,908.68 / $33,884.42	Facility		$3,235.94	$22,908.68	$33,884.42
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,230.27 / $1,659.59 / $2,630.27	Professional		$1,230.27	$1,659.59	$2,630.27
Anthem BCBS Facility/Professional Professional Modifier AS Low / Median / High Price $173.78 / $229.09 / $363.08	Professional	AS	$173.78	$229.09	$363.08
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $1,148.15 / $1,380.38 / $1,778.28	Professional		$1,148.15	$1,380.38	$1,778.28
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,230.27 / $1,584.89 / $2,089.30	Facility		$1,230.27	$1,584.89	$2,089.30
CareSource Facility/Professional Professional Modifier Low / Median / High Price $1,258.93 / $1,621.81 / $2,951.21	Professional		$1,258.93	$1,621.81	$2,951.21
Cigna Facility/Professional Facility Modifier Low / Median / High Price $21,379.62 / $25,703.96 / $25,703.96	Facility		$21,379.62	$25,703.96	$25,703.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,230.27 / $1,778.28 / $2,630.27	Professional		$1,230.27	$1,778.28	$2,630.27
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $6,309.57 / $12,022.64 / $25,703.96	Facility		$6,309.57	$12,022.64	$25,703.96
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $1,148.15 / $1,737.80 / $2,630.27	Professional		$1,148.15	$1,737.80	$2,630.27
Medical Mutual of Ohio Facility/Professional Professional Modifier AS Low / Median / High Price $52.48 / $181.97 / $295.12	Professional	AS	$52.48	$181.97	$295.12
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $288.40	Professional		$32.36	$33.11	$288.40
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $100.00 / $15,848.93	Facility		$100.00	$100.00	$15,848.93
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $1,174.90 / $1,584.89 / $2,630.27	Professional		$1,174.90	$1,584.89	$2,630.27
SummaCare Facility/Professional Professional Modifier AS Low / Median / High Price $316.23 / $331.13 / $398.11	Professional	AS	$316.23	$331.13	$398.11
United Facility/Professional Facility Modifier Low / Median / High Price $5,370.32 / $12,589.25 / $24,547.09	Facility		$5,370.32	$12,589.25	$24,547.09
United Facility/Professional Professional Modifier Low / Median / High Price $1,047.13 / $1,584.89 / $2,454.71	Professional		$1,047.13	$1,584.89	$2,454.71