Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $3,019.95 / $12,022.64 / $27,542.29	Facility		$3,019.95	$12,022.64	$27,542.29
Aetna Facility/Professional Facility Modifier 22 Low / Median / High Price $3,890.45 / $3,890.45 / $9,332.54	Facility	22	$3,890.45	$3,890.45	$9,332.54
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $4,897.79 / $16,595.87 / $38,018.94	Facility	50	$4,897.79	$16,595.87	$38,018.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $1,737.80 / $4,365.16	Professional		$645.65	$1,737.80	$4,365.16
Aetna Facility/Professional Professional Modifier AS Low / Median / High Price $169.82 / $323.59 / $660.69	Professional	AS	$169.82	$323.59	$660.69
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $1,122.02 / $1,621.81	Professional		$162.18	$1,122.02	$1,621.81
Ambetter Facility/Professional Professional Modifier AS Low / Median / High Price $302.00 / $302.00 / $302.00	Professional	AS	$302.00	$302.00	$302.00
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,137.96 / $23,442.29 / $37,153.52	Facility		$2,137.96	$23,442.29	$37,153.52
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,318.26 / $1,819.70 / $3,019.95	Professional		$1,318.26	$1,819.70	$3,019.95
Anthem BCBS Facility/Professional Professional Modifier AS Low / Median / High Price $181.97 / $257.04 / $416.87	Professional	AS	$181.97	$257.04	$416.87
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $1,318.26 / $1,584.89 / $1,778.28	Professional		$1,318.26	$1,584.89	$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 / $2,884.03	Professional		$1,258.93	$1,621.81	$2,884.03
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,778.28 / $21,379.62 / $23,988.33	Facility		$1,778.28	$21,379.62	$23,988.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,230.27 / $1,862.09 / $2,691.53	Professional		$1,230.27	$1,862.09	$2,691.53
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $6,165.95 / $11,220.18 / $21,379.62	Facility		$6,165.95	$11,220.18	$21,379.62
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $1,148.15 / $1,737.80 / $2,691.53	Professional		$1,148.15	$1,737.80	$2,691.53
Medical Mutual of Ohio Facility/Professional Professional Modifier AS Low / Median / High Price $66.07 / $93.33 / $177.83	Professional	AS	$66.07	$93.33	$177.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $309.03	Professional		$32.36	$33.11	$309.03
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 $257.04 / $331.13 / $398.11	Professional	AS	$257.04	$331.13	$398.11
United Facility/Professional Facility Modifier Low / Median / High Price $5,370.32 / $12,589.25 / $26,302.68	Facility		$5,370.32	$12,589.25	$26,302.68
United Facility/Professional Professional Modifier Low / Median / High Price $1,047.13 / $1,621.81 / $2,454.71	Professional		$1,047.13	$1,621.81	$2,454.71