Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $426.58 / $6,165.95	Facility		$204.17	$426.58	$6,165.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $204.17 / $446.68	Professional		$204.17	$204.17	$446.68
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $204.17 / $204.17	Professional		$204.17	$204.17	$204.17
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $218.78 / $331.13 / $724.44	Facility		$218.78	$331.13	$724.44
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $204.17 / $354.81	Professional		$204.17	$204.17	$354.81
CareSource Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $204.17 / $204.17	Facility		$204.17	$204.17	$204.17
CareSource Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $204.17 / $275.42	Professional		$204.17	$204.17	$275.42
Cigna Facility/Professional Facility Modifier Low / Median / High Price $194.98 / $194.98 / $204.17	Facility		$194.98	$194.98	$204.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $204.17 / $234.42	Professional		$199.53	$204.17	$234.42
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $194.98 / $199.53 / $204.17	Facility		$194.98	$199.53	$204.17
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $204.17 / $234.42	Professional		$199.53	$204.17	$234.42
Molina Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $223.87 / $295.12	Professional		$204.17	$223.87	$295.12
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $223.87 / $407.38	Professional		$100.00	$223.87	$407.38
United Facility/Professional Facility Modifier Low / Median / High Price $2.04 / $81.28 / $204.17	Facility		$2.04	$81.28	$204.17
United Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $204.17 / $208.93	Professional		$81.28	$204.17	$208.93