Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $134.90 / $223.87	Facility		$66.07	$134.90	$223.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $93.33 / $257.04	Professional		$57.54	$93.33	$257.04
Ambetter Facility/Professional Professional Modifier CQ Low / Median / High Price $120.23 / $120.23 / $120.23	Professional	CQ	$120.23	$120.23	$120.23
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $87.10 / $147.91	Professional		$63.10	$87.10	$147.91
Aultcare Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $131.83 / $131.83	Facility		$66.07	$131.83	$131.83
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $75.86 / $190.55	Professional		$66.07	$75.86	$190.55
CareSource Facility/Professional Facility Modifier Low / Median / High Price $91.20 / $107.15 / $128.82	Facility		$91.20	$107.15	$128.82
CareSource Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $107.15 / $218.78	Professional		$95.50	$107.15	$218.78
Cigna Facility/Professional Facility Modifier Low / Median / High Price $64.57 / $141.25 / $162.18	Facility		$64.57	$141.25	$162.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $83.18 / $147.91	Professional		$67.61	$83.18	$147.91
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $186.21 / $316.23	Facility		$107.15	$186.21	$316.23
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $87.10 / $144.54	Professional		$66.07	$87.10	$144.54
Medical Mutual of Ohio Facility/Professional Professional Modifier CQ Low / Median / High Price $134.90 / $134.90 / $134.90	Professional	CQ	$134.90	$134.90	$134.90
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $79.43	Professional		$32.36	$33.11	$79.43
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $112.20 / $112.20	Facility		$112.20	$112.20	$112.20
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $104.71 / $154.88	Professional		$83.18	$104.71	$154.88
United Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $77.62 / $97.72	Facility		$77.62	$77.62	$97.72
United Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $75.86 / $104.71	Professional		$58.88	$75.86	$104.71