Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $954.99 / $1,348.96 / $1,698.24	Facility		$954.99	$1,348.96	$1,698.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $776.25 / $933.25 / $1,412.54	Professional		$776.25	$933.25	$1,412.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $933.25 / $1,348.96 / $2,344.23	Professional		$933.25	$1,348.96	$2,344.23
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,819.70 / $1,905.46 / $3,890.45	Facility		$1,819.70	$1,905.46	$3,890.45
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $794.33 / $1,071.52 / $2,344.23	Professional		$794.33	$1,071.52	$2,344.23
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $1,513.56 / $1,513.56 / $1,513.56	Professional		$1,513.56	$1,513.56	$1,513.56
CareSource Facility/Professional Facility Modifier Low / Median / High Price $912.01 / $1,348.96 / $2,187.76	Facility		$912.01	$1,348.96	$2,187.76
CareSource Facility/Professional Professional Modifier Low / Median / High Price $1,174.90 / $1,621.81 / $2,454.71	Professional		$1,174.90	$1,621.81	$2,454.71
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,047.13 / $1,047.13 / $1,047.13	Facility		$1,047.13	$1,047.13	$1,047.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $758.58 / $758.58 / $1,047.13	Professional		$758.58	$758.58	$1,047.13
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $1,047.13 / $1,047.13 / $1,047.13	Facility		$1,047.13	$1,047.13	$1,047.13
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $758.58 / $758.58 / $1,047.13	Professional		$758.58	$758.58	$1,047.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $1,230.27 / $1,778.28	Professional		$870.96	$1,230.27	$1,778.28
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $2,187.76 / $2,187.76 / $2,187.76	Facility		$2,187.76	$2,187.76	$2,187.76
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $1,819.70 / $2,041.74 / $3,715.35	Professional		$1,819.70	$2,041.74	$3,715.35
United Facility/Professional Facility Modifier Low / Median / High Price $630.96 / $891.25 / $1,905.46	Facility		$630.96	$891.25	$1,905.46
United Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $851.14 / $1,288.25	Professional		$588.84	$851.14	$1,288.25