Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $156.76 / $2,173.48 / $9,504.00	Facility		$156.76	$2,173.48	$9,504.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $43.12 / $124.78 / $357.11	Facility	52	$43.12	$124.78	$357.11
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $17.25 / $49.91 / $142.84	Facility	53	$17.25	$49.91	$142.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $86.24 / $199.35 / $424.25	Professional		$86.24	$199.35	$424.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $78.26 / $78.26 / $78.26	Professional		$78.26	$78.26	$78.26
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $777.00 / $1,877.00 / $3,943.00	Facility		$777.00	$1,877.00	$3,943.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $90.00 / $193.51 / $370.97	Professional		$90.00	$193.51	$370.97
CareSource Facility/Professional Facility Modifier Low / Median / High Price $82.12 / $98.54 / $121.97	Facility		$82.12	$98.54	$121.97
CareSource Facility/Professional Professional Modifier Low / Median / High Price $102.65 / $257.92 / $304.81	Professional		$102.65	$257.92	$304.81
Cigna Facility/Professional Facility Modifier Low / Median / High Price $147.60 / $577.00 / $839.11	Facility		$147.60	$577.00	$839.11
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $118.08 / $118.08 / $118.08	Facility	52	$118.08	$118.08	$118.08
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $29.52 / $29.52 / $29.52	Facility	53	$29.52	$29.52	$29.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $95.10 / $212.92 / $426.31	Professional		$95.10	$212.92	$426.31
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $366.00 / $577.00 / $763.03	Facility		$366.00	$577.00	$763.03
Medical Mutual of Ohio Facility/Professional Facility Modifier 52 Low / Median / High Price $118.08 / $118.08 / $118.08	Facility	52	$118.08	$118.08	$118.08
Medical Mutual of Ohio Facility/Professional Facility Modifier 53 Low / Median / High Price $29.52 / $29.52 / $29.52	Facility	53	$29.52	$29.52	$29.52
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $98.55 / $216.59 / $432.50	Professional		$98.55	$216.59	$432.50
Molina Facility/Professional Professional Modifier Low / Median / High Price $186.66 / $259.06 / $360.36	Professional		$186.66	$259.06	$360.36
United Facility/Professional Facility Modifier Low / Median / High Price $675.00 / $2,499.00 / $5,235.00	Facility		$675.00	$2,499.00	$5,235.00
United Facility/Professional Professional Modifier Low / Median / High Price $198.93 / $273.52 / $477.19	Professional		$198.93	$273.52	$477.19