Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $52.48 / $309.03 / $309.03	Facility		$52.48	$309.03	$309.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $50.12 / $70.79	Professional		$38.02	$50.12	$70.79
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $102.33 / $107.15 / $218.78	Facility		$102.33	$107.15	$218.78
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $58.88 / $131.83	Professional		$46.77	$58.88	$131.83
CareSource Facility/Professional Facility Modifier Low / Median / High Price $46.77 / $69.18 / $112.20	Facility		$46.77	$69.18	$112.20
CareSource Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $83.18 / $125.89	Professional		$60.26	$83.18	$125.89
Cigna Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $53.70 / $53.70	Facility		$53.70	$53.70	$53.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $38.90 / $53.70	Professional		$38.90	$38.90	$53.70
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $53.70 / $53.70	Facility		$53.70	$53.70	$53.70
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $38.90 / $53.70	Professional		$38.90	$38.90	$53.70
Molina Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $77.62 / $109.65	Professional		$54.95	$77.62	$109.65
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $123.03 / $123.03 / $123.03	Facility		$123.03	$123.03	$123.03
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $114.82 / $208.93	Professional		$102.33	$114.82	$208.93
United Facility/Professional Facility Modifier Low / Median / High Price $33.88 / $46.77 / $100.00	Facility		$33.88	$46.77	$100.00
United Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $46.77 / $69.18	Professional		$33.11	$46.77	$69.18