Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,481.34 / $5,135.00 / $11,627.00	Facility		$1,481.34	$5,135.00	$11,627.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,481.34 / $1,481.34 / $2,945.06	Professional		$1,481.34	$1,481.34	$2,945.06
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $4,426.00 / $12,098.50 / $21,233.00	Facility		$4,426.00	$12,098.50	$21,233.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,204.04 / $1,707.61 / $2,724.24	Professional		$1,204.04	$1,707.61	$2,724.24
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,441.37 / $1,729.64 / $2,140.81	Facility		$1,441.37	$1,729.64	$2,140.81
CareSource Facility/Professional Professional Modifier Low / Median / High Price $1,585.51 / $1,585.51 / $1,731.46	Professional		$1,585.51	$1,585.51	$1,731.46
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 $1,222.30 / $1,999.81 / $3,001.15	Professional		$1,222.30	$1,999.81	$3,001.15
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $1,441.37 / $2,017.92 / $3,001.15	Professional		$1,441.37	$2,017.92	$3,001.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $188.38 / $1,238.14 / $2,020.57	Professional		$188.38	$1,238.14	$2,020.57
United Facility/Professional Facility Modifier Low / Median / High Price $5,351.00 / $10,346.00 / $15,298.00	Facility		$5,351.00	$10,346.00	$15,298.00
United Facility/Professional Professional Modifier Low / Median / High Price $1,391.47 / $1,855.30 / $3,104.84	Professional		$1,391.47	$1,855.30	$3,104.84