Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $162.18 / $204.17	Facility		$114.82	$162.18	$204.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $114.82 / $173.78	Professional		$87.10	$114.82	$173.78
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $218.78 / $234.42 / $467.74	Facility		$218.78	$234.42	$467.74
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $125.89 / $281.84	Professional		$104.71	$125.89	$281.84
CareSource Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $158.49 / $251.19	Facility		$104.71	$158.49	$251.19
CareSource Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $190.55 / $281.84	Professional		$138.04	$190.55	$281.84
Cigna Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $141.25 / $141.25	Facility		$141.25	$141.25	$141.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $102.33 / $141.25	Professional		$102.33	$102.33	$141.25
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $141.25 / $288.40	Facility		$141.25	$141.25	$288.40
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $102.33 / $141.25	Professional		$102.33	$102.33	$141.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $131.83 / $190.55	Professional		$93.33	$131.83	$190.55
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $263.03 / $263.03 / $263.03	Facility		$263.03	$263.03	$263.03
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $245.47 / $457.09	Professional		$218.78	$245.47	$457.09
United Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $117.49 / $245.47	Facility		$87.10	$117.49	$245.47
United Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $104.71 / $158.49	Professional		$72.44	$104.71	$158.49