Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $190.60 / $1,883.00 / $5,929.63	Facility		$190.60	$1,883.00	$5,929.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $78.01 / $190.60 / $320.26	Professional		$78.01	$190.60	$320.26
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $72.13 / $90.16 / $140.28	Professional		$72.13	$90.16	$140.28
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $937.00 / $1,927.00 / $3,943.00	Facility		$937.00	$1,927.00	$3,943.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $73.59 / $101.51 / $169.63	Professional		$73.59	$101.51	$169.63
CareSource Facility/Professional Facility Modifier Low / Median / High Price $78.84 / $94.59 / $120.24	Facility		$78.84	$94.59	$120.24
CareSource Facility/Professional Professional Modifier Low / Median / High Price $198.92 / $258.60 / $318.70	Professional		$198.92	$258.60	$318.70
Cigna Facility/Professional Facility Modifier Low / Median / High Price $145.07 / $145.07 / $21,571.00	Facility		$145.07	$145.07	$21,571.00
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $116.06 / $116.06 / $116.06	Facility	52	$116.06	$116.06	$116.06
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $29.01 / $29.01 / $29.01	Facility	53	$29.01	$29.01	$29.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $99.35 / $209.68 / $452.09	Professional		$99.35	$209.68	$452.09
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $145.07 / $1,060.28 / $3,128.49	Facility		$145.07	$1,060.28	$3,128.49
Medical Mutual of Ohio Facility/Professional Facility Modifier 52 Low / Median / High Price $116.06 / $116.06 / $116.06	Facility	52	$116.06	$116.06	$116.06
Medical Mutual of Ohio Facility/Professional Facility Modifier 53 Low / Median / High Price $29.01 / $29.01 / $29.01	Facility	53	$29.01	$29.01	$29.01
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $97.80 / $196.96 / $406.35	Professional		$97.80	$196.96	$406.35
Molina Facility/Professional Professional Modifier Low / Median / High Price $181.73 / $238.37 / $349.05	Professional		$181.73	$238.37	$349.05
United Facility/Professional Facility Modifier Low / Median / High Price $1,075.00 / $1,963.00 / $4,067.00	Facility		$1,075.00	$1,963.00	$4,067.00
United Facility/Professional Professional Modifier Low / Median / High Price $227.00 / $335.31 / $542.79	Professional		$227.00	$335.31	$542.79