Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $99.87 / $639.16 / $2,986.00	Facility		$99.87	$639.16	$2,986.00
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $574.41 / $1,168.11 / $2,986.00	Facility	25	$574.41	$1,168.11	$2,986.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $80.84 / $110.25 / $249.21	Professional		$80.84	$110.25	$249.21
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $99.38 / $257.39 / $446.76	Professional	25	$99.38	$257.39	$446.76
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $115.12 / $178.09 / $437.06	Professional		$115.12	$178.09	$437.06
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $111.54 / $158.69 / $324.69	Professional	25	$111.54	$158.69	$324.69
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $96.43 / $137.50 / $237.81	Professional		$96.43	$137.50	$237.81
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $126.63 / $149.66 / $184.19	Professional		$126.63	$149.66	$184.19
CareSource Facility/Professional Facility Modifier Low / Median / High Price $115.12 / $132.38 / $172.68	Facility		$115.12	$132.38	$172.68
CareSource Facility/Professional Professional Modifier Low / Median / High Price $115.69 / $149.66 / $255.06	Professional		$115.69	$149.66	$255.06
Cigna Facility/Professional Facility Modifier Low / Median / High Price $139.63 / $139.63 / $1,724.00	Facility		$139.63	$139.63	$1,724.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $107.11 / $146.58 / $252.45	Professional		$107.11	$146.58	$252.45
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $139.63 / $857.95 / $1,751.01	Facility		$139.63	$857.95	$1,751.01
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $115.12 / $178.43 / $379.10	Professional		$115.12	$178.43	$379.10
Molina Facility/Professional Professional Modifier Low / Median / High Price $107.97 / $154.46 / $209.59	Professional		$107.97	$154.46	$209.59
Optum Facility/Professional Professional Modifier Low / Median / High Price $103.75 / $154.79 / $279.64	Professional		$103.75	$154.79	$279.64
United Facility/Professional Professional Modifier Low / Median / High Price $92.56 / $138.13 / $243.96	Professional		$92.56	$138.13	$243.96