Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $687.44 / $3,966.00 / $9,504.00	Facility		$687.44	$3,966.00	$9,504.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $109.26 / $343.72 / $1,077.38	Facility	52	$109.26	$343.72	$1,077.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $218.52 / $616.70 / $1,144.43	Professional		$218.52	$616.70	$1,144.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $183.25 / $203.61 / $256.55	Professional		$183.25	$203.61	$256.55
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $918.00 / $2,118.00 / $8,800.00	Facility		$918.00	$2,118.00	$8,800.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $222.07 / $559.23 / $1,047.16	Professional		$222.07	$559.23	$1,047.16
CareSource Facility/Professional Facility Modifier Low / Median / High Price $209.48 / $251.38 / $311.13	Facility		$209.48	$251.38	$311.13
CareSource Facility/Professional Professional Modifier Low / Median / High Price $261.85 / $700.11 / $827.40	Professional		$261.85	$700.11	$827.40
Cigna Facility/Professional Facility Modifier Low / Median / High Price $377.53 / $1,197.95 / $1,738.96	Facility		$377.53	$1,197.95	$1,738.96
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $302.02 / $302.02 / $302.02	Facility	52	$302.02	$302.02	$302.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $240.90 / $489.84 / $1,193.33	Professional		$240.90	$489.84	$1,193.33
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $530.00 / $1,197.95 / $2,547.39	Facility		$530.00	$1,197.95	$2,547.39
Medical Mutual of Ohio Facility/Professional Facility Modifier 52 Low / Median / High Price $302.02 / $302.02 / $302.02	Facility	52	$302.02	$302.02	$302.02
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $249.22 / $484.80 / $1,145.63	Professional		$249.22	$484.80	$1,145.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $604.48 / $817.54 / $1,131.01	Professional		$604.48	$817.54	$1,131.01
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 $606.55 / $863.52 / $1,406.50	Professional		$606.55	$863.52	$1,406.50