Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $235.32 / $610.05 / $3,847.00	Facility		$235.32	$610.05	$3,847.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $150.50 / $223.79 / $521.24	Facility	54	$150.50	$223.79	$521.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $175.61 / $221.02 / $430.75	Professional		$175.61	$221.02	$430.75
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $135.19 / $159.37 / $283.04	Professional	54	$135.19	$159.37	$283.04
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $207.62 / $242.56 / $321.81	Professional		$207.62	$242.56	$321.81
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 $94.18 / $144.05 / $286.77	Professional		$94.18	$144.05	$286.77
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $234.61 / $249.14 / $249.14	Professional		$234.61	$249.14	$249.14
CareSource Facility/Professional Facility Modifier Low / Median / High Price $196.43 / $235.72 / $294.64	Facility		$196.43	$235.72	$294.64
CareSource Facility/Professional Professional Modifier Low / Median / High Price $214.47 / $269.91 / $341.93	Professional		$214.47	$269.91	$341.93
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 $200.86 / $275.00 / $397.23	Professional		$200.86	$275.00	$397.23
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $211.07 / $289.66 / $521.27	Facility		$211.07	$289.66	$521.27
Medical Mutual of Ohio Facility/Professional Facility Modifier 54 Low / Median / High Price $245.76 / $245.76 / $245.76	Facility	54	$245.76	$245.76	$245.76
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $200.86 / $280.49 / $405.25	Professional		$200.86	$280.49	$405.25
Medical Mutual of Ohio Facility/Professional Professional Modifier 54 Low / Median / High Price $252.34 / $252.34 / $252.34	Professional	54	$252.34	$252.34	$252.34
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.53 / $173.49 / $287.87	Professional		$32.53	$173.49	$287.87
United Facility/Professional Facility Modifier Low / Median / High Price $180.20 / $738.00 / $2,816.00	Facility		$180.20	$738.00	$2,816.00
United Facility/Professional Professional Modifier Low / Median / High Price $169.44 / $257.27 / $427.08	Professional		$169.44	$257.27	$427.08