Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,012.44 / $6,011.00 / $9,496.00	Facility		$1,012.44	$6,011.00	$9,496.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $1,310.52 / $2,621.04 / $11,476.79	Facility	50	$1,310.52	$2,621.04	$11,476.79
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $107.83 / $160.34 / $407.90	Facility	53	$107.83	$160.34	$407.90
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $404.35 / $601.26 / $1,529.63	Facility	54	$404.35	$601.26	$1,529.63
Aetna Facility/Professional Facility Modifier 55 Low / Median / High Price $80.87 / $120.25 / $305.93	Facility	55	$80.87	$120.25	$305.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $539.13 / $850.91 / $3,669.25	Professional		$539.13	$850.91	$3,669.25
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $747.96 / $747.96 / $1,293.90	Professional	50	$747.96	$747.96	$1,293.90
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $260.37 / $281.88 / $474.71	Professional	52	$260.37	$281.88	$474.71
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $404.35 / $439.88 / $712.07	Professional	54	$404.35	$439.88	$712.07
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $78.11 / $84.56 / $142.41	Professional	55	$78.11	$84.56	$142.41
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $463.74 / $498.64 / $688.55	Professional		$463.74	$498.64	$688.55
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,191.00 / $3,232.00 / $8,800.00	Facility		$1,191.00	$3,232.00	$8,800.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $562.91 / $692.63 / $1,323.92	Professional		$562.91	$692.63	$1,323.92
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $844.36 / $1,038.94 / $1,985.88	Professional	50	$844.36	$1,038.94	$1,985.88
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $563.46 / $563.46 / $563.46	Professional		$563.46	$563.46	$563.46
CareSource Facility/Professional Facility Modifier Low / Median / High Price $498.64 / $623.29 / $747.96	Facility		$498.64	$623.29	$747.96
CareSource Facility/Professional Professional Modifier Low / Median / High Price $498.64 / $623.29 / $821.22	Professional		$498.64	$623.29	$821.22
Cigna Facility/Professional Facility Modifier Low / Median / High Price $602.32 / $1,124.08 / $21,571.00	Facility		$602.32	$1,124.08	$21,571.00
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $120.35 / $120.35 / $120.35	Facility	53	$120.35	$120.35	$120.35
Cigna Facility/Professional Facility Modifier 54 Low / Median / High Price $421.21 / $421.21 / $421.21	Facility	54	$421.21	$421.21	$421.21
Cigna Facility/Professional Facility Modifier 55 Low / Median / High Price $90.26 / $90.26 / $90.26	Facility	55	$90.26	$90.26	$90.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $450.35 / $723.03 / $1,436.17	Professional		$450.35	$723.03	$1,436.17
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $1,253.49 / $3,234.11 / $7,508.42	Facility		$1,253.49	$3,234.11	$7,508.42
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $485.03 / $713.81 / $1,195.44	Professional		$485.03	$713.81	$1,195.44
Medical Mutual of Ohio Facility/Professional Professional Modifier 54 Low / Median / High Price $351.42 / $464.06 / $1,076.95	Professional	54	$351.42	$464.06	$1,076.95
Medical Mutual of Ohio Facility/Professional Professional Modifier 55 Low / Median / High Price $7.50 / $30.00 / $115.39	Professional	55	$7.50	$30.00	$115.39
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.28 / $379.39 / $658.91	Professional		$75.28	$379.39	$658.91
United Facility/Professional Facility Modifier Low / Median / High Price $2,233.00 / $4,321.00 / $7,351.00	Facility		$2,233.00	$4,321.00	$7,351.00
United Facility/Professional Professional Modifier Low / Median / High Price $487.30 / $670.03 / $1,178.36	Professional		$487.30	$670.03	$1,178.36