Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $575.44 / $2,691.53 / $7,413.10	Facility		$575.44	$2,691.53	$7,413.10
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $954.99 / $1,318.26 / $1,905.46	Facility	52	$954.99	$1,318.26	$1,905.46
Aetna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $436.52 / $1,202.26	Professional		$194.98	$436.52	$1,202.26
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $194.98 / $275.42 / $1,023.29	Professional	52	$194.98	$275.42	$1,023.29
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $69.18 / $158.49 / $524.81	Professional	53	$69.18	$158.49	$524.81
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $218.78 / $331.13	Professional		$158.49	$218.78	$331.13
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $22.91 / $22.91 / $66.07	Professional	52	$22.91	$22.91	$66.07
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $158.49 / $177.83 / $588.84	Professional	53	$158.49	$177.83	$588.84
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,000.00 / $3,019.95 / $6,165.95	Facility		$1,000.00	$3,019.95	$6,165.95
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $302.00 / $512.86	Professional		$208.93	$302.00	$512.86
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $275.42 / $354.81	Professional		$213.80	$275.42	$354.81
CareSource Facility/Professional Facility Modifier Low / Median / High Price $190.55 / $245.47 / $323.59	Facility		$190.55	$245.47	$323.59
CareSource Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $501.19 / $933.25	Professional		$389.05	$501.19	$933.25
Cigna Facility/Professional Facility Modifier Low / Median / High Price $309.03 / $537.03 / $1,659.59	Facility		$309.03	$537.03	$1,659.59
Cigna Facility/Professional Facility Modifier 22 Low / Median / High Price $407.38 / $407.38 / $407.38	Facility	22	$407.38	$407.38	$407.38
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $269.15 / $269.15 / $269.15	Facility	52	$269.15	$269.15	$269.15
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $67.61 / $67.61 / $67.61	Facility	53	$67.61	$67.61	$67.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $407.38 / $776.25	Professional		$218.78	$407.38	$776.25
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $309.03 / $309.03 / $309.03	Professional	53	$309.03	$309.03	$309.03
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $707.95 / $1,513.56 / $3,467.37	Facility		$707.95	$1,513.56	$3,467.37
Medical Mutual of Ohio Facility/Professional Facility Modifier 22 Low / Median / High Price $407.38 / $407.38 / $407.38	Facility	22	$407.38	$407.38	$407.38
Medical Mutual of Ohio Facility/Professional Facility Modifier 52 Low / Median / High Price $269.15 / $269.15 / $269.15	Facility	52	$269.15	$269.15	$269.15
Medical Mutual of Ohio Facility/Professional Facility Modifier 53 Low / Median / High Price $67.61 / $67.61 / $67.61	Facility	53	$67.61	$67.61	$67.61
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $302.00 / $660.69	Professional		$138.04	$302.00	$660.69
Medical Mutual of Ohio Facility/Professional Professional Modifier 52 Low / Median / High Price $380.19 / $380.19 / $478.63	Professional	52	$380.19	$380.19	$478.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $223.87	Professional		$32.36	$33.11	$223.87
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $562.34 / $1,479.11	Facility		$100.00	$562.34	$1,479.11
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $467.74 / $707.95	Professional		$208.93	$467.74	$707.95
United Facility/Professional Facility Modifier Low / Median / High Price $676.08 / $2,290.87 / $4,897.79	Facility		$676.08	$2,290.87	$4,897.79
United Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $371.54 / $660.69	Professional		$186.21	$371.54	$660.69