Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $511.56 / $2,794.05 / $5,806.58	Facility		$511.56	$2,794.05	$5,806.58
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $87.61 / $158.91 / $470.31	Facility	52	$87.61	$158.91	$470.31
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $63.50 / $158.78 / $290.56	Facility	53	$63.50	$158.78	$290.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $175.21 / $317.51 / $572.66	Professional		$175.21	$317.51	$572.66
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $35.15 / $87.92 / $204.80	Professional	53	$35.15	$87.92	$204.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $169.95 / $190.19 / $269.72	Professional		$169.95	$190.19	$269.72
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $85.12 / $90.53 / $157.80	Professional	53	$85.12	$90.53	$157.80
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $777.00 / $1,931.00 / $3,943.00	Facility		$777.00	$1,931.00	$3,943.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $182.90 / $332.28 / $523.60	Professional		$182.90	$332.28	$523.60
Anthem BCBS Facility/Professional Professional Modifier 53 Low / Median / High Price $96.29 / $164.25 / $256.14	Professional	53	$96.29	$164.25	$256.14
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $172.90 / $172.90 / $172.90	Professional		$172.90	$172.90	$172.90
Aultcare Facility/Professional Professional Modifier 53 Low / Median / High Price $86.60 / $86.60 / $86.60	Professional	53	$86.60	$86.60	$86.60
CareSource Facility/Professional Facility Modifier Low / Median / High Price $22.73 / $172.90 / $241.63	Facility		$22.73	$172.90	$241.63
CareSource Facility/Professional Professional Modifier Low / Median / High Price $44.46 / $301.13 / $496.86	Professional		$44.46	$301.13	$496.86
Cigna Facility/Professional Facility Modifier Low / Median / High Price $243.68 / $611.00 / $885.00	Facility		$243.68	$611.00	$885.00
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $194.94 / $194.94 / $194.94	Facility	52	$194.94	$194.94	$194.94
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $48.74 / $48.74 / $48.74	Facility	53	$48.74	$48.74	$48.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $301.75 / $301.75 / $301.75	Professional		$301.75	$301.75	$301.75
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $41.90 / $159.44 / $723.33	Professional	53	$41.90	$159.44	$723.33
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $709.33 / $1,576.89 / $3,569.13	Facility		$709.33	$1,576.89	$3,569.13
Medical Mutual of Ohio Facility/Professional Facility Modifier 52 Low / Median / High Price $194.94 / $194.94 / $194.94	Facility	52	$194.94	$194.94	$194.94
Medical Mutual of Ohio Facility/Professional Facility Modifier 53 Low / Median / High Price $48.74 / $48.74 / $48.74	Facility	53	$48.74	$48.74	$48.74
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $240.37 / $301.75 / $382.20	Professional		$240.37	$301.75	$382.20
Medical Mutual of Ohio Facility/Professional Professional Modifier 53 Low / Median / High Price $144.07 / $159.44 / $723.33	Professional	53	$144.07	$159.44	$723.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $153.09 / $252.60 / $413.21	Professional		$153.09	$252.60	$413.21
United Facility/Professional Facility Modifier Low / Median / High Price $487.00 / $1,848.00 / $4,067.00	Facility		$487.00	$1,848.00	$4,067.00
United Facility/Professional Professional Modifier Low / Median / High Price $289.27 / $418.39 / $700.63	Professional		$289.27	$418.39	$700.63
United Facility/Professional Professional Modifier 53 Low / Median / High Price $88.55 / $88.55 / $88.55	Professional	53	$88.55	$88.55	$88.55