Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $270.92 / $1,902.00 / $3,847.00	Facility		$270.92	$1,902.00	$3,847.00
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $17.63 / $48.86 / $156.56	Facility	53	$17.63	$48.86	$156.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.02 / $198.83 / $421.26	Professional		$89.02	$198.83	$421.26
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $86.84 / $121.38 / $250.25	Professional		$86.84	$121.38	$250.25
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $814.00 / $1,927.00 / $3,943.00	Facility		$814.00	$1,927.00	$3,943.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $85.92 / $112.69 / $190.58	Professional		$85.92	$112.69	$190.58
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $105.51 / $105.51 / $112.04	Professional		$105.51	$105.51	$112.04
CareSource Facility/Professional Facility Modifier Low / Median / High Price $93.37 / $112.04 / $140.06	Facility		$93.37	$112.04	$140.06
CareSource Facility/Professional Professional Modifier Low / Median / High Price $241.17 / $299.89 / $379.93	Professional		$241.17	$299.89	$379.93
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 $109.24 / $202.66 / $404.89	Professional		$109.24	$202.66	$404.89
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $895.18 / $1,559.26 / $3,064.40	Facility		$895.18	$1,559.26	$3,064.40
Medical Mutual of Ohio Facility/Professional Facility Modifier 53 Low / Median / High Price $33.71 / $33.71 / $33.71	Facility	53	$33.71	$33.71	$33.71
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $109.24 / $198.68 / $415.24	Professional		$109.24	$198.68	$415.24
Molina Facility/Professional Professional Modifier Low / Median / High Price $216.39 / $281.87 / $400.12	Professional		$216.39	$281.87	$400.12
United Facility/Professional Facility Modifier Low / Median / High Price $1,020.00 / $1,940.00 / $4,067.00	Facility		$1,020.00	$1,940.00	$4,067.00
United Facility/Professional Professional Modifier Low / Median / High Price $200.00 / $314.43 / $456.95	Professional		$200.00	$314.43	$456.95