Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $362.43 / $1,501.00 / $4,975.00	Facility		$362.43	$1,501.00	$4,975.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $738.16 / $762.86 / $3,498.57	Facility	50	$738.16	$762.86	$3,498.57
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $230.63 / $367.45 / $785.68	Facility	54	$230.63	$367.45	$785.68
Aetna Facility/Professional Facility Modifier 55 Low / Median / High Price $46.13 / $73.48 / $157.13	Facility	55	$46.13	$73.48	$157.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $276.70 / $345.07 / $625.02	Professional		$276.70	$345.07	$625.02
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $562.74 / $617.29 / $682.80	Professional	50	$562.74	$617.29	$682.80
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $214.96 / $247.11 / $435.69	Professional	54	$214.96	$247.11	$435.69
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $42.99 / $49.42 / $87.14	Professional	55	$42.99	$49.42	$87.14
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $223.01 / $333.70 / $423.18	Professional		$223.01	$333.70	$423.18
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $513.42 / $513.42 / $527.76	Professional	50	$513.42	$513.42	$527.76
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $937.00 / $2,012.00 / $3,943.00	Facility		$937.00	$2,012.00	$3,943.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $231.98 / $312.83 / $558.69	Professional		$231.98	$312.83	$558.69
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $347.97 / $468.94 / $838.03	Professional	50	$347.97	$468.94	$838.03
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $319.91 / $319.91 / $341.57	Professional		$319.91	$319.91	$341.57
CareSource Facility/Professional Facility Modifier Low / Median / High Price $283.11 / $353.89 / $424.67	Facility		$283.11	$353.89	$424.67
CareSource Facility/Professional Professional Modifier Low / Median / High Price $302.27 / $375.06 / $497.82	Professional		$302.27	$375.06	$497.82
Cigna Facility/Professional Facility Modifier Low / Median / High Price $272.64 / $304.02 / $21,571.00	Facility		$272.64	$304.02	$21,571.00
Cigna Facility/Professional Facility Modifier 54 Low / Median / High Price $355.52 / $355.52 / $355.52	Facility	54	$355.52	$355.52	$355.52
Cigna Facility/Professional Facility Modifier 55 Low / Median / High Price $76.18 / $76.18 / $76.18	Facility	55	$76.18	$76.18	$76.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $264.27 / $385.62 / $657.84	Professional		$264.27	$385.62	$657.84
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $304.02 / $933.80 / $1,698.86	Facility		$304.02	$933.80	$1,698.86
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $273.83 / $382.63 / $583.21	Professional		$273.83	$382.63	$583.21
Medical Mutual of Ohio Facility/Professional Professional Modifier 54 Low / Median / High Price $407.88 / $407.88 / $407.88	Professional	54	$407.88	$407.88	$407.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $36.79 / $209.92 / $374.81	Professional		$36.79	$209.92	$374.81
United Facility/Professional Facility Modifier Low / Median / High Price $745.00 / $1,848.00 / $3,923.00	Facility		$745.00	$1,848.00	$3,923.00
United Facility/Professional Professional Modifier Low / Median / High Price $268.88 / $342.78 / $720.15	Professional		$268.88	$342.78	$720.15