Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $165.96 / $1,819.70 / $4,786.30	Facility		$165.96	$1,819.70	$4,786.30
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $676.08 / $2,818.38 / $7,943.28	Facility	50	$676.08	$2,818.38	$7,943.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $194.98 / $446.68	Professional		$102.33	$194.98	$446.68
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $275.42 / $338.84 / $1,148.15	Professional	50	$275.42	$338.84	$1,148.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $173.78 / $346.74	Professional		$95.50	$173.78	$346.74
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $144.54 / $269.15 / $478.63	Professional	50	$144.54	$269.15	$478.63
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $707.95 / $2,238.72 / $3,981.07	Facility		$707.95	$2,238.72	$3,981.07
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $128.82 / $208.93	Professional		$93.33	$128.82	$208.93
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $141.25 / $194.98 / $309.03	Professional	50	$141.25	$194.98	$309.03
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $112.20 / $112.20	Professional		$112.20	$112.20	$112.20
CareSource Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $128.82 / $169.82	Facility		$100.00	$128.82	$169.82
CareSource Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $239.88 / $407.38	Professional		$181.97	$239.88	$407.38
Cigna Facility/Professional Facility Modifier Low / Median / High Price $21,379.62 / $21,379.62 / $21,379.62	Facility		$21,379.62	$21,379.62	$21,379.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $194.98 / $331.13	Professional		$112.20	$194.98	$331.13
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $691.83 / $1,023.29 / $2,511.89	Facility		$691.83	$1,023.29	$2,511.89
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $190.55 / $338.84	Professional		$104.71	$190.55	$338.84
Medical Mutual of Ohio Facility/Professional Professional Modifier 50 Low / Median / High Price $234.42 / $245.47 / $398.11	Professional	50	$234.42	$245.47	$398.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $58.88	Professional		$32.36	$33.11	$58.88
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $100.00 / $1,096.48	Facility		$100.00	$100.00	$1,096.48
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $204.17 / $309.03	Professional		$95.50	$204.17	$309.03
United Facility/Professional Facility Modifier Low / Median / High Price $954.99 / $1,862.09 / $4,073.80	Facility		$954.99	$1,862.09	$4,073.80
United Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $165.96 / $331.13	Professional		$91.20	$165.96	$331.13