Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $123.03 / $177.83	Facility		$100.00	$123.03	$177.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $93.33 / $128.82	Professional		$66.07	$93.33	$128.82
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $190.55 / $199.53 / $407.38	Facility		$190.55	$199.53	$407.38
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $107.15 / $239.88	Professional		$91.20	$107.15	$239.88
CareSource Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $151.36 / $239.88	Facility		$100.00	$151.36	$239.88
CareSource Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $181.97 / $275.42	Professional		$131.83	$181.97	$275.42
Cigna Facility/Professional Facility Modifier Low / Median / High Price $131.83 / $131.83 / $131.83	Facility		$131.83	$131.83	$131.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $97.72 / $131.83	Professional		$97.72	$97.72	$131.83
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $131.83 / $131.83 / $275.42	Facility		$131.83	$131.83	$275.42
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $97.72 / $112.20	Professional		$97.72	$97.72	$112.20
Molina Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $131.83 / $194.98	Professional		$85.11	$131.83	$194.98
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $229.09 / $229.09 / $229.09	Facility		$229.09	$229.09	$229.09
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $213.80 / $389.05	Professional		$190.55	$213.80	$389.05
United Facility/Professional Facility Modifier Low / Median / High Price $63.10 / $83.18 / $173.78	Facility		$63.10	$83.18	$173.78
United Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $85.11 / $120.23	Professional		$56.23	$85.11	$120.23