Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $58.88 / $91.20 / $147.91	Facility		$58.88	$91.20	$147.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $50.12 / $74.13	Professional		$42.66	$50.12	$74.13
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $66.07 / $114.82	Facility		$57.54	$66.07	$114.82
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $47.86 / $79.43	Professional		$38.90	$47.86	$79.43
CareSource Facility/Professional Facility Modifier Low / Median / High Price $42.66 / $42.66 / $70.79	Facility		$42.66	$42.66	$70.79
CareSource Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $977.24 / $1,737.80	Professional		$75.86	$977.24	$1,737.80
Cigna Facility/Professional Facility Modifier Low / Median / High Price $40.74 / $40.74 / $131.83	Facility		$40.74	$40.74	$131.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $70.79 / $89.13	Professional		$40.74	$70.79	$89.13
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $40.74 / $64.57 / $131.83	Facility		$40.74	$64.57	$131.83
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $40.74 / $40.74	Professional		$40.74	$40.74	$40.74
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $74.13 / $74.13 / $74.13	Facility		$74.13	$74.13	$74.13
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $64.57 / $123.03	Professional		$40.74	$64.57	$123.03
United Facility/Professional Facility Modifier Low / Median / High Price $22.39 / $40.74 / $61.66	Facility		$22.39	$40.74	$61.66
United Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $37.15 / $61.66	Professional		$26.30	$37.15	$61.66