Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,737.80 / $2,398.83 / $3,019.95	Facility		$1,737.80	$2,398.83	$3,019.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,202.26 / $1,659.59 / $2,398.83	Professional		$1,202.26	$1,659.59	$2,398.83
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,311.31 / $3,467.37 / $7,079.46	Facility		$3,311.31	$3,467.37	$7,079.46
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,584.89 / $1,819.70 / $4,168.69	Professional		$1,584.89	$1,819.70	$4,168.69
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,513.56 / $2,290.87 / $3,630.78	Facility		$1,513.56	$2,290.87	$3,630.78
CareSource Facility/Professional Professional Modifier Low / Median / High Price $1,949.84 / $2,691.53 / $4,073.80	Professional		$1,949.84	$2,691.53	$4,073.80
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,819.70 / $1,819.70 / $1,819.70	Facility		$1,819.70	$1,819.70	$1,819.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,318.26 / $1,318.26 / $1,819.70	Professional		$1,318.26	$1,318.26	$1,819.70
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $1,819.70 / $1,819.70 / $4,073.80	Facility		$1,819.70	$1,819.70	$4,073.80
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $1,318.26 / $1,318.26 / $1,819.70	Professional		$1,318.26	$1,318.26	$1,819.70
Molina Facility/Professional Professional Modifier Low / Median / High Price $1,412.54 / $1,949.84 / $2,818.38	Professional		$1,412.54	$1,949.84	$2,818.38
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $3,981.07 / $3,981.07 / $3,981.07	Facility		$3,981.07	$3,981.07	$3,981.07
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $3,311.31 / $3,715.35 / $6,760.83	Professional		$3,311.31	$3,715.35	$6,760.83
United Facility/Professional Facility Modifier Low / Median / High Price $1,202.26 / $1,621.81 / $3,388.44	Facility		$1,202.26	$1,621.81	$3,388.44
United Facility/Professional Professional Modifier Low / Median / High Price $1,071.52 / $1,513.56 / $2,238.72	Professional		$1,071.52	$1,513.56	$2,238.72