Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $28.18 / $48.98 / $107.15	Facility		$28.18	$48.98	$107.15
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $46.77 / $95.50 / $120.23	Facility	25	$46.77	$95.50	$120.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $52.48 / $117.49	Professional		$28.18	$52.48	$117.49
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $31.62 / $58.88 / $134.90	Professional	25	$31.62	$58.88	$134.90
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $53.70 / $79.43	Professional		$30.90	$53.70	$79.43
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $41.69 / $54.95 / $77.62	Professional	25	$41.69	$54.95	$77.62
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $39.81 / $67.61	Professional		$26.30	$39.81	$67.61
Anthem BCBS Facility/Professional Professional Modifier 25 Low / Median / High Price $34.67 / $34.67 / $34.67	Professional	25	$34.67	$34.67	$34.67
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $54.95 / $91.20	Professional		$33.11	$54.95	$91.20
CareSource Facility/Professional Facility Modifier Low / Median / High Price $32.36 / $39.81 / $54.95	Facility		$32.36	$39.81	$54.95
CareSource Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $58.88 / $112.20	Professional		$51.29	$58.88	$112.20
Cigna Facility/Professional Facility Modifier Low / Median / High Price $30.90 / $66.07 / $158.49	Facility		$30.90	$66.07	$158.49
Cigna Facility/Professional Facility Modifier 22 Low / Median / High Price $64.57 / $64.57 / $64.57	Facility	22	$64.57	$64.57	$64.57
Cigna Facility/Professional Facility Modifier 62 Low / Median / High Price $33.88 / $33.88 / $33.88	Facility	62	$33.88	$33.88	$33.88
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $5.37 / $5.37 / $5.37	Facility	AS	$5.37	$5.37	$5.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $46.77 / $87.10	Professional		$27.54	$46.77	$87.10
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $50.12 / $128.82 / $251.19	Facility		$50.12	$128.82	$251.19
Medical Mutual of Ohio Facility/Professional Facility Modifier 22 Low / Median / High Price $56.23 / $56.23 / $56.23	Facility	22	$56.23	$56.23	$56.23
Medical Mutual of Ohio Facility/Professional Facility Modifier 62 Low / Median / High Price $29.51 / $29.51 / $29.51	Facility	62	$29.51	$29.51	$29.51
Medical Mutual of Ohio Facility/Professional Facility Modifier AS Low / Median / High Price $4.68 / $4.68 / $4.68	Facility	AS	$4.68	$4.68	$4.68
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $50.12 / $77.62	Professional		$29.51	$50.12	$77.62
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $33.11 / $63.10	Professional		$19.95	$33.11	$63.10
Optum Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $53.70 / $100.00	Professional		$39.81	$53.70	$100.00
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $50.12 / $75.86	Professional		$33.88	$50.12	$75.86
United Facility/Professional Facility Modifier Low / Median / High Price $48.98 / $48.98 / $48.98	Facility		$48.98	$48.98	$48.98
United Facility/Professional Professional Modifier Low / Median / High Price $22.39 / $38.90 / $66.07	Professional		$22.39	$38.90	$66.07