Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $186.21 / $34,673.69	Facility		$87.10	$186.21	$34,673.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $87.10 / $181.97	Professional		$85.11	$87.10	$181.97
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $87.10	Professional		$87.10	$87.10	$87.10
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $93.33 / $138.04 / $309.03	Facility		$93.33	$138.04	$309.03
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $97.72 / $147.91	Professional		$87.10	$97.72	$147.91
Aultcare Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $204.17 / $204.17	Facility		$204.17	$204.17	$204.17
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $87.10	Professional		$87.10	$87.10	$87.10
CareSource Facility/Professional Facility Modifier Low / Median / High Price $85.11 / $85.11 / $128.82	Facility		$85.11	$85.11	$128.82
CareSource Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $85.11 / $199.53	Professional		$85.11	$85.11	$199.53
Cigna Facility/Professional Facility Modifier Low / Median / High Price $81.28 / $81.28 / $125.89	Facility		$81.28	$81.28	$125.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $109.65	Professional		$87.10	$87.10	$109.65
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $81.28 / $112.20 / $281.84	Facility		$81.28	$112.20	$281.84
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $123.03	Professional		$87.10	$87.10	$123.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $95.50 / $123.03	Professional		$85.11	$95.50	$123.03
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $102.33 / $165.96	Professional		$87.10	$102.33	$165.96
United Facility/Professional Facility Modifier Low / Median / High Price $85.11 / $87.10 / $87.10	Facility		$85.11	$87.10	$87.10
United Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $87.10 / $97.72	Professional		$81.28	$87.10	$97.72