Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $48.98 / $165.96 / $295.12	Facility		$48.98	$165.96	$295.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $229.09 / $575.44	Professional		$141.25	$229.09	$575.44
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $173.78 / $323.59 / $724.44	Professional	25	$173.78	$323.59	$724.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $218.78 / $331.13	Professional		$158.49	$218.78	$331.13
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $173.78 / $218.78 / $316.23	Professional	25	$173.78	$218.78	$316.23
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $181.97 / $295.12	Professional		$144.54	$181.97	$295.12
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $223.87 / $316.23	Professional		$177.83	$223.87	$316.23
CareSource Facility/Professional Facility Modifier Low / Median / High Price $169.82 / $204.17 / $288.40	Facility		$169.82	$204.17	$288.40
CareSource Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $234.42 / $446.68	Professional		$208.93	$234.42	$446.68
Cigna Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $147.91 / $281.84	Facility		$104.71	$147.91	$281.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $223.87 / $389.05	Professional		$158.49	$223.87	$389.05
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $154.88 / $239.88	Facility		$104.71	$154.88	$239.88
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $239.88 / $371.54	Professional		$158.49	$239.88	$371.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $128.82	Professional		$32.36	$33.11	$128.82
Optum Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $229.09 / $371.54	Professional		$104.71	$229.09	$371.54
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $239.88 / $363.08	Professional		$173.78	$239.88	$363.08
United Facility/Professional Facility Modifier Low / Median / High Price $169.82 / $169.82 / $169.82	Facility		$169.82	$169.82	$169.82
United Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $199.53 / $309.03	Professional		$138.04	$199.53	$309.03