Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $363.08 / $891.25	Facility		$107.15	$363.08	$891.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $95.50 / $147.91	Professional		$93.33	$95.50	$147.91
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $93.33 / $93.33	Professional		$93.33	$93.33	$93.33
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $102.33 / $173.78 / $616.60	Facility		$102.33	$173.78	$616.60
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $104.71 / $165.96	Professional		$93.33	$104.71	$165.96
Aultcare Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $128.82 / $128.82	Facility		$128.82	$128.82	$128.82
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $95.50 / $95.50	Professional		$95.50	$95.50	$95.50
CareSource Facility/Professional Facility Modifier Low / Median / High Price $95.50 / $95.50 / $95.50	Facility		$95.50	$95.50	$95.50
CareSource Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $128.82 / $128.82	Professional		$128.82	$128.82	$128.82
Cigna Facility/Professional Facility Modifier Low / Median / High Price $89.13 / $89.13 / $93.33	Facility		$89.13	$89.13	$93.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $93.33 / $141.25	Professional		$93.33	$93.33	$141.25
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $89.13 / $141.25 / $354.81	Facility		$89.13	$141.25	$354.81
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $93.33 / $141.25	Professional		$93.33	$93.33	$141.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $117.49 / $134.90	Professional		$93.33	$117.49	$134.90
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $158.49 / $218.78	Professional		$95.50	$158.49	$218.78
United Facility/Professional Facility Modifier Low / Median / High Price $93.33 / $93.33 / $93.33	Facility		$93.33	$93.33	$93.33
United Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $93.33 / $100.00	Professional		$91.20	$93.33	$100.00