Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,737.80 / $7,079.46 / $12,022.64	Facility		$1,737.80	$7,079.46	$12,022.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $831.76 / $1,047.13 / $5,754.40	Professional		$831.76	$1,047.13	$5,754.40
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,235.94 / $6,025.60 / $22,908.68	Facility		$3,235.94	$6,025.60	$22,908.68
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $831.76 / $1,071.52 / $1,698.24	Professional		$831.76	$1,071.52	$1,698.24
CareSource Facility/Professional Facility Modifier Low / Median / High Price $891.25 / $891.25 / $1,047.13	Facility		$891.25	$891.25	$1,047.13
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,071.52 / $1,445.44 / $21,379.62	Facility		$1,071.52	$1,445.44	$21,379.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $1,230.27 / $1,778.28	Professional		$870.96	$1,230.27	$1,778.28
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $21,379.62 / $21,379.62 / $21,379.62	Facility		$21,379.62	$21,379.62	$21,379.62
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $812.83 / $1,230.27 / $1,778.28	Professional		$812.83	$1,230.27	$1,778.28
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $100.00 / $8,912.51	Facility		$100.00	$100.00	$8,912.51
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $1,000.00 / $1,905.46	Professional		$870.96	$1,000.00	$1,905.46
United Facility/Professional Facility Modifier Low / Median / High Price $2,951.21 / $6,025.60 / $9,332.54	Facility		$2,951.21	$6,025.60	$9,332.54
United Facility/Professional Professional Modifier Low / Median / High Price $676.08 / $1,047.13 / $1,621.81	Professional		$676.08	$1,047.13	$1,621.81