Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,884.03 / $6,165.95 / $9,120.11	Facility		$2,884.03	$6,165.95	$9,120.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $2,884.03 / $3,019.95 / $3,715.35	Professional		$2,884.03	$3,019.95	$3,715.35
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,162.28 / $5,370.32 / $19,498.45	Facility		$3,162.28	$5,370.32	$19,498.45
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,290.87 / $2,754.23 / $4,168.69	Professional		$2,290.87	$2,754.23	$4,168.69
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,000.00 / $1,000.00 / $1,000.00	Facility		$1,000.00	$1,000.00	$1,000.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $3,090.30 / $3,090.30 / $3,090.30	Facility		$3,090.30	$3,090.30	$3,090.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $3,090.30 / $3,090.30 / $4,897.79	Professional		$3,090.30	$3,090.30	$4,897.79
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $3,090.30 / $3,090.30 / $3,090.30	Facility		$3,090.30	$3,090.30	$3,090.30
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $3,090.30 / $3,090.30 / $4,897.79	Professional		$3,090.30	$3,090.30	$4,897.79
Molina Facility/Professional Professional Modifier Low / Median / High Price $2,290.87 / $2,884.03 / $3,311.31	Professional		$2,290.87	$2,884.03	$3,311.31
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $3,467.37 / $3,467.37 / $3,467.37	Facility		$3,467.37	$3,467.37	$3,467.37
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $3,235.94 / $4,365.16 / $7,413.10	Professional		$3,235.94	$4,365.16	$7,413.10
United Facility/Professional Facility Modifier Low / Median / High Price $2,884.03 / $2,884.03 / $2,884.03	Facility		$2,884.03	$2,884.03	$2,884.03
United Facility/Professional Professional Modifier Low / Median / High Price $3,019.95 / $3,019.95 / $3,235.94	Professional		$3,019.95	$3,019.95	$3,235.94