Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $446.68 / $3,388.44 / $6,456.54	Facility		$446.68	$3,388.44	$6,456.54
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $87.10 / $158.49 / $281.84	Facility	53	$87.10	$158.49	$281.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $331.13 / $912.01	Professional		$169.82	$331.13	$912.01
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $69.18 / $128.82 / $239.88	Professional	53	$69.18	$128.82	$239.88
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $173.78 / $251.19	Professional		$165.96	$173.78	$251.19
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $87.10 / $87.10 / $144.54	Professional	53	$87.10	$87.10	$144.54
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $776.25 / $2,238.72 / $4,466.84	Facility		$776.25	$2,238.72	$4,466.84
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $331.13 / $524.81	Professional		$181.97	$331.13	$524.81
Anthem BCBS Facility/Professional Professional Modifier 53 Low / Median / High Price $89.13 / $177.83 / $275.42	Professional	53	$89.13	$177.83	$275.42
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $173.78 / $173.78	Professional		$173.78	$173.78	$173.78
Aultcare Facility/Professional Professional Modifier 53 Low / Median / High Price $87.10 / $87.10 / $87.10	Professional	53	$87.10	$87.10	$87.10
CareSource Facility/Professional Facility Modifier Low / Median / High Price $24.55 / $169.82 / $269.15	Facility		$24.55	$169.82	$269.15
CareSource Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $208.93 / $489.78	Professional		$41.69	$208.93	$489.78
Cigna Facility/Professional Facility Modifier Low / Median / High Price $371.54 / $602.56 / $1,862.09	Facility		$371.54	$602.56	$1,862.09
Cigna Facility/Professional Facility Modifier 22 Low / Median / High Price $446.68 / $446.68 / $446.68	Facility	22	$446.68	$446.68	$446.68
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $295.12 / $295.12 / $295.12	Facility	52	$295.12	$295.12	$295.12
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $74.13 / $74.13 / $74.13	Facility	53	$74.13	$74.13	$74.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $302.00 / $302.00	Professional		$302.00	$302.00	$302.00
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $41.69 / $144.54 / $457.09	Professional	53	$41.69	$144.54	$457.09
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $707.95 / $1,737.80 / $3,715.35	Facility		$707.95	$1,737.80	$3,715.35
Medical Mutual of Ohio Facility/Professional Facility Modifier 22 Low / Median / High Price $446.68 / $446.68 / $446.68	Facility	22	$446.68	$446.68	$446.68
Medical Mutual of Ohio Facility/Professional Facility Modifier 52 Low / Median / High Price $295.12 / $295.12 / $295.12	Facility	52	$295.12	$295.12	$295.12
Medical Mutual of Ohio Facility/Professional Facility Modifier 53 Low / Median / High Price $74.13 / $74.13 / $74.13	Facility	53	$74.13	$74.13	$74.13
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $302.00 / $354.81	Professional		$234.42	$302.00	$354.81
Medical Mutual of Ohio Facility/Professional Professional Modifier 53 Low / Median / High Price $107.15 / $173.78 / $457.09	Professional	53	$107.15	$173.78	$457.09
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $645.65 / $645.65 / $1,148.15	Facility		$645.65	$645.65	$1,148.15
SummaCare Facility/Professional Facility Modifier 53 Low / Median / High Price $1,148.15 / $1,148.15 / $1,148.15	Facility	53	$1,148.15	$1,148.15	$1,148.15
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $354.81 / $707.95	Professional		$162.18	$354.81	$707.95
SummaCare Facility/Professional Professional Modifier 53 Low / Median / High Price $79.43 / $177.83 / $354.81	Professional	53	$79.43	$177.83	$354.81
United Facility/Professional Facility Modifier Low / Median / High Price $489.78 / $1,778.28 / $3,981.07	Facility		$489.78	$1,778.28	$3,981.07
United Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $309.03 / $524.81	Professional		$173.78	$309.03	$524.81