Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $831.76 / $1,122.02 / $1,479.11	Facility		$831.76	$1,122.02	$1,479.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $794.33 / $1,096.48	Professional		$524.81	$794.33	$1,096.48
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,584.89 / $1,698.24 / $3,388.44	Facility		$1,584.89	$1,698.24	$3,388.44
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $758.58 / $891.25 / $2,041.74	Professional		$758.58	$891.25	$2,041.74
CareSource Facility/Professional Facility Modifier Low / Median / High Price $831.76 / $1,230.27 / $1,995.26	Facility		$831.76	$1,230.27	$1,995.26
CareSource Facility/Professional Professional Modifier Low / Median / High Price $1,071.52 / $1,479.11 / $2,238.72	Professional		$1,071.52	$1,479.11	$2,238.72
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,023.29 / $1,023.29 / $1,023.29	Facility		$1,023.29	$1,023.29	$1,023.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $741.31 / $1,023.29	Professional		$741.31	$741.31	$1,023.29
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $1,023.29 / $1,023.29 / $2,238.72	Facility		$1,023.29	$1,023.29	$2,238.72
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $741.31 / $851.14	Professional		$741.31	$741.31	$851.14
Molina Facility/Professional Professional Modifier Low / Median / High Price $676.08 / $954.99 / $1,380.38	Professional		$676.08	$954.99	$1,380.38
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $1,905.46 / $1,905.46 / $1,905.46	Facility		$1,905.46	$1,905.46	$1,905.46
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $1,584.89 / $1,778.28 / $3,311.31	Professional		$1,584.89	$1,778.28	$3,311.31
United Facility/Professional Facility Modifier Low / Median / High Price $489.78 / $676.08 / $1,445.44	Facility		$489.78	$676.08	$1,445.44
United Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $707.95 / $1,000.00	Professional		$478.63	$707.95	$1,000.00