Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $19.95 / $40.74 / $69.18	Facility		$19.95	$40.74	$69.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $19.95 / $45.71	Professional		$19.95	$19.95	$45.71
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $21.88 / $43.65 / $131.83	Facility		$21.88	$43.65	$131.83
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $22.39 / $35.48	Professional		$19.95	$22.39	$35.48
CareSource Facility/Professional Facility Modifier Low / Median / High Price $64.57 / $64.57 / $64.57	Facility		$64.57	$64.57	$64.57
CareSource Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $87.10	Professional		$87.10	$87.10	$87.10
Cigna Facility/Professional Facility Modifier Low / Median / High Price $19.05 / $19.05 / $19.95	Facility		$19.05	$19.05	$19.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $19.95 / $134.90	Professional		$19.95	$19.95	$134.90
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $19.05 / $19.05 / $48.98	Facility		$19.05	$19.05	$48.98
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $19.95 / $134.90	Professional		$19.95	$19.95	$134.90
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $29.51 / $91.20	Professional		$19.95	$29.51	$91.20
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $154.88 / $213.80	Professional		$91.20	$154.88	$213.80
United Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $19.95 / $29.51	Professional		$19.95	$19.95	$29.51