Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $442.85 / $2,232.44 / $5,600.64	Facility		$442.85	$2,232.44	$5,600.64
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $90.09 / $242.96 / $1,118.28	Facility	52	$90.09	$242.96	$1,118.28
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $65.36 / $163.24 / $308.20	Facility	53	$65.36	$163.24	$308.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $180.17 / $326.77 / $619.90	Professional		$180.17	$326.77	$619.90
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $38.65 / $101.20 / $235.48	Professional	53	$38.65	$101.20	$235.48
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $154.41 / $198.45 / $258.83	Professional		$154.41	$198.45	$258.83
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $43.44 / $86.60 / $116.22	Professional	53	$43.44	$86.60	$116.22
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $861.00 / $1,981.00 / $3,943.00	Facility		$861.00	$1,981.00	$3,943.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $174.98 / $256.89 / $458.50	Professional		$174.98	$256.89	$458.50
Anthem BCBS Facility/Professional Professional Modifier 53 Low / Median / High Price $90.54 / $112.40 / $190.76	Professional	53	$90.54	$112.40	$190.76
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $194.99 / $194.99 / $274.37	Professional		$194.99	$194.99	$274.37
Aultcare Facility/Professional Professional Modifier 53 Low / Median / High Price $97.86 / $97.86 / $137.69	Professional	53	$97.86	$97.86	$137.69
CareSource Facility/Professional Facility Modifier Low / Median / High Price $21.83 / $161.34 / $240.79	Facility		$21.83	$161.34	$240.79
CareSource Facility/Professional Professional Modifier Low / Median / High Price $44.46 / $300.83 / $496.39	Professional		$44.46	$300.83	$496.39
Cigna Facility/Professional Facility Modifier Low / Median / High Price $310.83 / $611.00 / $888.46	Facility		$310.83	$611.00	$888.46
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $248.66 / $248.66 / $248.66	Facility	52	$248.66	$248.66	$248.66
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $62.17 / $62.17 / $62.17	Facility	53	$62.17	$62.17	$62.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $198.45 / $341.83 / $605.13	Professional		$198.45	$341.83	$605.13
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $100.92 / $116.81 / $267.63	Professional	53	$100.92	$116.81	$267.63
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $699.07 / $1,592.00 / $3,150.86	Facility		$699.07	$1,592.00	$3,150.86
Medical Mutual of Ohio Facility/Professional Facility Modifier 52 Low / Median / High Price $248.66 / $248.66 / $248.66	Facility	52	$248.66	$248.66	$248.66
Medical Mutual of Ohio Facility/Professional Facility Modifier 53 Low / Median / High Price $62.17 / $62.17 / $62.17	Facility	53	$62.17	$62.17	$62.17
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $189.65 / $319.82 / $598.60	Professional		$189.65	$319.82	$598.60
Medical Mutual of Ohio Facility/Professional Professional Modifier 53 Low / Median / High Price $35.11 / $100.92 / $267.63	Professional	53	$35.11	$100.92	$267.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $154.16 / $256.04 / $416.32	Professional		$154.16	$256.04	$416.32
United Facility/Professional Facility Modifier Low / Median / High Price $675.00 / $2,297.00 / $5,235.00	Facility		$675.00	$2,297.00	$5,235.00
United Facility/Professional Professional Modifier Low / Median / High Price $237.97 / $383.50 / $647.07	Professional		$237.97	$383.50	$647.07
United Facility/Professional Professional Modifier 53 Low / Median / High Price $80.52 / $244.62 / $736.57	Professional	53	$80.52	$244.62	$736.57