Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $165.28 / $544.82 / $4,275.00	Facility		$165.28	$544.82	$4,275.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $88.31 / $131.32 / $292.27	Facility	54	$88.31	$131.32	$292.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.07 / $123.60 / $228.96	Professional		$102.07	$123.60	$228.96
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $75.77 / $88.55 / $156.30	Professional	54	$75.77	$88.55	$156.30
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $79.91 / $115.94 / $150.72	Professional		$79.91	$115.94	$150.72
Ambetter Facility/Professional Professional Modifier 54 Low / Median / High Price $140.08 / $165.56 / $194.78	Professional	54	$140.08	$165.56	$194.78
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 $54.71 / $83.59 / $162.28	Professional		$54.71	$83.59	$162.28
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $131.01 / $139.13 / $139.13	Professional		$131.01	$139.13	$139.13
CareSource Facility/Professional Facility Modifier Low / Median / High Price $108.41 / $118.26 / $172.21	Facility		$108.41	$118.26	$172.21
CareSource Facility/Professional Professional Modifier Low / Median / High Price $87.73 / $127.53 / $162.32	Professional		$87.73	$127.53	$162.32
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 $116.82 / $162.31 / $230.36	Professional		$116.82	$162.31	$230.36
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $141.36 / $353.06 / $519.30	Facility		$141.36	$353.06	$519.30
Medical Mutual of Ohio Facility/Professional Facility Modifier 54 Low / Median / High Price $94.65 / $94.65 / $94.65	Facility	54	$94.65	$94.65	$94.65
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $118.80 / $168.11 / $230.36	Professional		$118.80	$168.11	$230.36
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.13 / $66.81 / $131.21	Professional		$29.13	$66.81	$131.21
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 $95.33 / $143.88 / $229.76	Professional		$95.33	$143.88	$229.76