Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $46.77 / $112.20 / $239.88	Facility		$46.77	$112.20	$239.88
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $45.71 / $95.50 / $269.15	Facility	25	$45.71	$95.50	$269.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $169.82 / $407.38	Professional		$95.50	$169.82	$407.38
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $107.15 / $204.17 / $478.63	Professional	25	$107.15	$204.17	$478.63
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $173.78 / $257.04	Professional		$123.03	$173.78	$257.04
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $138.04 / $181.97 / $263.03	Professional	25	$138.04	$181.97	$263.03
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $131.83 / $218.78	Professional		$97.72	$131.83	$218.78
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $186.21 / $257.04	Professional		$141.25	$186.21	$257.04
CareSource Facility/Professional Facility Modifier Low / Median / High Price $131.83 / $162.18 / $229.09	Facility		$131.83	$162.18	$229.09
CareSource Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $190.55 / $363.08	Professional		$165.96	$190.55	$363.08
Cigna Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $151.36 / $223.87	Facility		$109.65	$151.36	$223.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $165.96 / $295.12	Professional		$112.20	$165.96	$295.12
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $151.36 / $190.55	Facility		$109.65	$151.36	$190.55
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $186.21 / $269.15	Professional		$117.49	$186.21	$269.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $104.71	Professional		$32.36	$33.11	$104.71
Optum Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $169.82 / $295.12	Professional		$93.33	$169.82	$295.12
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $194.98 / $281.84	Professional		$138.04	$194.98	$281.84
United Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $138.04 / $223.87	Professional		$93.33	$138.04	$223.87