Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $120.23 / $199.53	Facility		$100.00	$120.23	$199.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $120.23 / $173.78	Professional		$93.33	$120.23	$173.78
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $30.20 / $125.89 / $125.89	Professional	25	$30.20	$125.89	$125.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $134.90 / $158.49	Professional		$114.82	$134.90	$158.49
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $117.49 / $123.03 / $147.91	Professional	25	$117.49	$123.03	$147.91
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $117.49 / $223.87	Professional		$91.20	$117.49	$223.87
CareSource Facility/Professional Facility Modifier Low / Median / High Price $186.21 / $186.21 / $186.21	Facility		$186.21	$186.21	$186.21
CareSource Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $194.98 / $194.98	Professional		$194.98	$194.98	$194.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $158.49 / $218.78	Professional		$120.23	$158.49	$218.78
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $120.23 / $218.78	Professional		$107.15	$120.23	$218.78
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $32.36 / $33.11	Professional		$32.36	$32.36	$33.11
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $186.21 / $316.23	Professional		$151.36	$186.21	$316.23
United Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $151.36 / $218.78	Professional		$112.20	$151.36	$218.78