Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $43.58 / $57.87 / $153.00	Facility		$43.58	$57.87	$153.00
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $45.86 / $59.26 / $180.50	Facility	25	$45.86	$59.26	$180.50
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $48.81 / $48.81 / $48.81	Facility	50	$48.81	$48.81	$48.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $45.48 / $74.73 / $148.00	Professional		$45.48	$74.73	$148.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $46.42 / $86.66 / $175.84	Professional	25	$46.42	$86.66	$175.84
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $254.64 / $271.76 / $524.16	Professional	50	$254.64	$271.76	$524.16
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $60.50 / $84.56 / $119.24	Professional		$60.50	$84.56	$119.24
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $70.31 / $85.17 / $112.21	Professional	25	$70.31	$85.17	$112.21
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $46.68 / $68.98 / $109.67	Professional		$46.68	$68.98	$109.67
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $62.19 / $85.17 / $111.57	Professional		$62.19	$85.17	$111.57
CareSource Facility/Professional Facility Modifier Low / Median / High Price $61.85 / $74.01 / $93.29	Facility		$61.85	$74.01	$93.29
CareSource Facility/Professional Professional Modifier Low / Median / High Price $85.17 / $110.72 / $166.60	Professional		$85.17	$110.72	$166.60
Cigna Facility/Professional Facility Modifier Low / Median / High Price $88.08 / $110.00 / $180.00	Facility		$88.08	$110.00	$180.00
Cigna Facility/Professional Facility Modifier 62 Low / Median / High Price $55.05 / $55.05 / $55.05	Facility	62	$55.05	$55.05	$55.05
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $8.81 / $8.81 / $8.81	Facility	AS	$8.81	$8.81	$8.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $50.90 / $84.77 / $134.11	Professional		$50.90	$84.77	$134.11
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $88.08 / $110.00 / $205.00	Facility		$88.08	$110.00	$205.00
Medical Mutual of Ohio Facility/Professional Facility Modifier 62 Low / Median / High Price $55.05 / $55.05 / $55.05	Facility	62	$55.05	$55.05	$55.05
Medical Mutual of Ohio Facility/Professional Facility Modifier AS Low / Median / High Price $8.81 / $8.81 / $8.81	Facility	AS	$8.81	$8.81	$8.81
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $63.52 / $96.30 / $135.91	Professional		$63.52	$96.30	$135.91
Medical Mutual of Ohio Facility/Professional Professional Modifier 50 Low / Median / High Price $285.36 / $285.36 / $285.36	Professional	50	$285.36	$285.36	$285.36
Molina Facility/Professional Professional Modifier Low / Median / High Price $52.54 / $73.09 / $102.02	Professional		$52.54	$73.09	$102.02
Optum Facility/Professional Professional Modifier Low / Median / High Price $69.34 / $90.82 / $133.50	Professional		$69.34	$90.82	$133.50
United Facility/Professional Professional Modifier Low / Median / High Price $56.97 / $83.77 / $137.60	Professional		$56.97	$83.77	$137.60