Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $89.71 / $189.51 / $346.00	Facility		$89.71	$189.51	$346.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $124.17 / $160.60 / $254.19	Professional		$124.17	$160.60	$254.19
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $221.52 / $221.52 / $221.52	Professional	25	$221.52	$221.52	$221.52
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $111.58 / $145.54 / $211.38	Professional		$111.58	$145.54	$211.38
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $120.00 / $120.00 / $123.00	Facility		$120.00	$120.00	$123.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $101.25 / $158.69 / $262.64	Professional		$101.25	$158.69	$262.64
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $137.86 / $183.81 / $275.72	Professional		$137.86	$183.81	$275.72
CareSource Facility/Professional Facility Modifier Low / Median / High Price $121.28 / $161.71 / $218.31	Facility		$121.28	$161.71	$218.31
CareSource Facility/Professional Professional Modifier Low / Median / High Price $151.63 / $208.78 / $257.33	Professional		$151.63	$208.78	$257.33
Cigna Facility/Professional Facility Modifier Low / Median / High Price $280.49 / $280.49 / $280.49	Facility		$280.49	$280.49	$280.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $107.10 / $181.00 / $324.00	Professional		$107.10	$181.00	$324.00
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $280.49 / $280.49 / $280.49	Facility		$280.49	$280.49	$280.49
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $120.08 / $192.00 / $319.94	Professional		$120.08	$192.00	$319.94
Molina Facility/Professional Professional Modifier Low / Median / High Price $135.02 / $174.73 / $245.88	Professional		$135.02	$174.73	$245.88
Optum Facility/Professional Professional Modifier Low / Median / High Price $118.07 / $175.53 / $279.64	Professional		$118.07	$175.53	$279.64
United Facility/Professional Professional Modifier Low / Median / High Price $116.76 / $183.97 / $381.68	Professional		$116.76	$183.97	$381.68