Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $430.45 / $5,201.00 / $11,627.00	Facility		$430.45	$5,201.00	$11,627.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $2,644.72 / $2,644.72 / $5,624.25	Facility	50	$2,644.72	$2,644.72	$5,624.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $252.34 / $2,883.06 / $5,469.16	Professional		$252.34	$2,883.06	$5,469.16
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $9,046.78 / $9,046.78 / $9,061.61	Professional	50	$9,046.78	$9,046.78	$9,061.61
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,895.00 / $5,945.00 / $29,406.00	Facility		$1,895.00	$5,945.00	$29,406.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $255.04 / $2,403.65 / $5,390.61	Professional		$255.04	$2,403.65	$5,390.61
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $382.56 / $3,605.48 / $8,047.70	Professional	50	$382.56	$3,605.48	$8,047.70
Anthem BCBS Facility/Professional Professional Modifier AS Low / Median / High Price $35.70 / $336.51 / $751.11	Professional	AS	$35.70	$336.51	$751.11
CareSource Facility/Professional Facility Modifier Low / Median / High Price $240.61 / $288.73 / $383.48	Facility		$240.61	$288.73	$383.48
CareSource Facility/Professional Professional Modifier Low / Median / High Price $2,880.20 / $4,127.59 / $5,105.81	Professional		$2,880.20	$4,127.59	$5,105.81
Cigna Facility/Professional Facility Modifier Low / Median / High Price $21,571.00 / $21,571.00 / $21,571.00	Facility		$21,571.00	$21,571.00	$21,571.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $264.67 / $2,260.30 / $6,104.49	Professional		$264.67	$2,260.30	$6,104.49
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $288.74 / $2,644.54 / $6,123.80	Professional		$288.74	$2,644.54	$6,123.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $2,484.81 / $3,381.91 / $4,743.69	Professional		$2,484.81	$3,381.91	$4,743.69
United Facility/Professional Facility Modifier Low / Median / High Price $2,874.00 / $6,111.00 / $7,853.00	Facility		$2,874.00	$6,111.00	$7,853.00
United Facility/Professional Professional Modifier Low / Median / High Price $3,078.69 / $4,066.42 / $7,207.63	Professional		$3,078.69	$4,066.42	$7,207.63