Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $151.36 / $1,513.56 / $4,677.35	Facility		$151.36	$1,513.56	$4,677.35
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $676.08 / $2,818.38 / $5,754.40	Facility	50	$676.08	$2,818.38	$5,754.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $177.83 / $426.58	Professional		$87.10	$177.83	$426.58
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $169.82 / $316.23 / $977.24	Professional	50	$169.82	$316.23	$977.24
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $162.18 / $323.59	Professional		$83.18	$162.18	$323.59
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $125.89 / $213.80 / $380.19	Professional	50	$125.89	$213.80	$380.19
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 $79.43 / $109.65 / $177.83	Professional		$79.43	$109.65	$177.83
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $120.23 / $165.96 / $269.15	Professional	50	$120.23	$165.96	$269.15
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $95.50 / $158.49	Professional		$95.50	$95.50	$158.49
CareSource Facility/Professional Facility Modifier Low / Median / High Price $85.11 / $109.65 / $144.54	Facility		$85.11	$109.65	$144.54
CareSource Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $218.78 / $380.19	Professional		$165.96	$218.78	$380.19
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 $95.50 / $173.78 / $295.12	Professional		$95.50	$173.78	$295.12
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $457.09 / $851.14 / $1,778.28	Facility		$457.09	$851.14	$1,778.28
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $162.18 / $295.12	Professional		$87.10	$162.18	$295.12
Medical Mutual of Ohio Facility/Professional Professional Modifier 50 Low / Median / High Price $128.82 / $128.82 / $549.54	Professional	50	$128.82	$128.82	$549.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $50.12	Professional		$32.36	$33.11	$50.12
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 $83.18 / $186.21 / $281.84	Professional		$83.18	$186.21	$281.84
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 $77.62 / $147.91 / $295.12	Professional		$77.62	$147.91	$295.12