Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $158.49 / $213.80	Facility		$54.95	$158.49	$213.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $36.31 / $61.66	Professional		$30.20	$36.31	$61.66
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $54.95 / $100.00	Professional		$28.84	$54.95	$100.00
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $74.13 / $77.62 / $158.49	Facility		$74.13	$77.62	$158.49
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $44.67 / $93.33	Professional		$35.48	$44.67	$93.33
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $61.66 / $61.66	Professional		$61.66	$61.66	$61.66
CareSource Facility/Professional Facility Modifier Low / Median / High Price $36.31 / $54.95 / $87.10	Facility		$36.31	$54.95	$87.10
CareSource Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $66.07 / $97.72	Professional		$46.77	$66.07	$97.72
Cigna Facility/Professional Facility Modifier Low / Median / High Price $46.77 / $46.77 / $47.86	Facility		$46.77	$46.77	$47.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $33.88 / $46.77	Professional		$33.88	$33.88	$46.77
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $44.67 / $46.77 / $47.86	Facility		$44.67	$46.77	$47.86
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $33.88 / $46.77	Professional		$33.88	$33.88	$46.77
Molina Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $48.98 / $69.18	Professional		$34.67	$48.98	$69.18
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $25.70 / $25.70 / $89.13	Facility		$25.70	$25.70	$89.13
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $83.18 / $151.36	Professional		$74.13	$83.18	$151.36
United Facility/Professional Facility Modifier Low / Median / High Price $26.92 / $48.98 / $74.13	Facility		$26.92	$48.98	$74.13
United Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $35.48 / $56.23	Professional		$23.99	$35.48	$56.23