Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $576.85 / $3,502.00 / $9,000.50	Facility		$576.85	$3,502.00	$9,000.50
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $1,722.50 / $5,529.00 / $6,569.24	Facility	50	$1,722.50	$5,529.00	$6,569.24
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $76.88 / $192.29 / $741.96	Facility	52	$76.88	$192.29	$741.96
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $30.75 / $76.91 / $296.77	Facility	53	$30.75	$76.91	$296.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $143.80 / $286.11 / $771.71	Professional		$143.80	$286.11	$771.71
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $153.22 / $429.16 / $816.67	Professional	50	$153.22	$429.16	$816.67
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $1,048.04 / $1,048.04 / $1,048.04	Professional		$1,048.04	$1,048.04	$1,048.04
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $1,572.06 / $1,572.06 / $1,572.06	Professional	50	$1,572.06	$1,572.06	$1,572.06
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,760.00 / $3,576.00 / $14,996.00	Facility		$1,760.00	$3,576.00	$14,996.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $136.38 / $304.22 / $572.96	Professional		$136.38	$304.22	$572.96
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $204.57 / $456.33 / $859.44	Professional	50	$204.57	$456.33	$859.44
CareSource Facility/Professional Facility Modifier Low / Median / High Price $146.22 / $182.79 / $217.19	Facility		$146.22	$182.79	$217.19
CareSource Facility/Professional Professional Modifier Low / Median / High Price $373.81 / $441.78 / $766.26	Professional		$373.81	$441.78	$766.26
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 $161.24 / $304.58 / $747.14	Professional		$161.24	$304.58	$747.14
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $1,141.29 / $2,704.67 / $7,551.73	Facility		$1,141.29	$2,704.67	$7,551.73
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $168.50 / $307.08 / $748.89	Professional		$168.50	$307.08	$748.89
Molina Facility/Professional Professional Modifier Low / Median / High Price $311.14 / $422.97 / $576.41	Professional		$311.14	$422.97	$576.41
United Facility/Professional Facility Modifier Low / Median / High Price $2,233.00 / $4,383.00 / $6,522.00	Facility		$2,233.00	$4,383.00	$6,522.00
United Facility/Professional Professional Modifier Low / Median / High Price $388.10 / $542.66 / $934.72	Professional		$388.10	$542.66	$934.72