Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $372.28 / $1,805.72 / $4,008.59	Facility		$372.28	$1,805.72	$4,008.59
Aetna Facility/Professional Facility Modifier 22 Low / Median / High Price $803.50 / $803.50 / $803.50	Facility	22	$803.50	$803.50	$803.50
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $952.26 / $3,464.00 / $6,816.88	Facility	50	$952.26	$3,464.00	$6,816.88
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $28.70 / $62.49 / $142.34	Facility	53	$28.70	$62.49	$142.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.09 / $219.71 / $563.16	Professional		$95.09	$219.71	$563.16
Aetna Facility/Professional Professional Modifier 22 Low / Median / High Price $141.52 / $141.52 / $191.19	Professional	22	$141.52	$141.52	$191.19
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $180.85 / $342.12 / $1,238.00	Professional	50	$180.85	$342.12	$1,238.00
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $20.16 / $42.22 / $108.19	Professional	53	$20.16	$42.22	$108.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $104.23 / $125.07 / $221.22	Professional		$104.23	$125.07	$221.22
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $145.40 / $187.61 / $464.56	Professional	50	$145.40	$187.61	$464.56
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,051.00 / $1,981.00 / $3,943.00	Facility		$1,051.00	$1,981.00	$3,943.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $79.93 / $112.56 / $197.66	Professional		$79.93	$112.56	$197.66
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $119.89 / $168.85 / $296.49	Professional	50	$119.89	$168.85	$296.49
CareSource Facility/Professional Facility Modifier Low / Median / High Price $104.23 / $125.08 / $156.35	Facility		$104.23	$125.08	$156.35
CareSource Facility/Professional Professional Modifier Low / Median / High Price $231.25 / $287.58 / $447.98	Professional		$231.25	$287.58	$447.98
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 $121.72 / $207.27 / $402.56	Professional		$121.72	$207.27	$402.56
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $718.00 / $1,286.53 / $2,061.83	Facility		$718.00	$1,286.53	$2,061.83
Medical Mutual of Ohio Facility/Professional Facility Modifier 53 Low / Median / High Price $37.61 / $37.61 / $37.61	Facility	53	$37.61	$37.61	$37.61
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $122.79 / $216.13 / $402.56	Professional		$122.79	$216.13	$402.56
Medical Mutual of Ohio Facility/Professional Professional Modifier 50 Low / Median / High Price $153.09 / $348.45 / $744.00	Professional	50	$153.09	$348.45	$744.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $182.42 / $244.92 / $349.85	Professional		$182.42	$244.92	$349.85
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 $194.30 / $310.27 / $467.45	Professional		$194.30	$310.27	$467.45