Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,621.81 / $1,621.81 / $2,630.27	Facility		$1,621.81	$1,621.81	$2,630.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,230.27 / $1,621.81 / $2,454.71	Professional		$1,230.27	$1,621.81	$2,454.71
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,388.44 / $3,548.13 / $7,244.36	Facility		$3,388.44	$3,548.13	$7,244.36
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,659.59 / $1,905.46 / $4,265.80	Professional		$1,659.59	$1,905.46	$4,265.80
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,445.44 / $2,187.76 / $3,467.37	Facility		$1,445.44	$2,187.76	$3,467.37
CareSource Facility/Professional Professional Modifier Low / Median / High Price $1,862.09 / $2,570.40 / $3,890.45	Professional		$1,862.09	$2,570.40	$3,890.45
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,737.80 / $1,737.80 / $1,737.80	Facility		$1,737.80	$1,737.80	$1,737.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,258.93 / $1,258.93 / $1,737.80	Professional		$1,258.93	$1,258.93	$1,737.80
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $1,737.80 / $1,737.80 / $1,737.80	Facility		$1,737.80	$1,737.80	$1,737.80
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $1,258.93 / $1,258.93 / $1,737.80	Professional		$1,258.93	$1,258.93	$1,737.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $1,819.70 / $2,570.40 / $3,630.78	Professional		$1,819.70	$2,570.40	$3,630.78
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $4,073.80 / $4,073.80 / $4,073.80	Facility		$4,073.80	$4,073.80	$4,073.80
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $3,388.44 / $3,801.89 / $6,918.31	Professional		$3,388.44	$3,801.89	$6,918.31
United Facility/Professional Facility Modifier Low / Median / High Price $1,258.93 / $2,089.30 / $3,235.94	Facility		$1,258.93	$2,089.30	$3,235.94
United Facility/Professional Professional Modifier Low / Median / High Price $1,096.48 / $1,621.81 / $2,137.96	Professional		$1,096.48	$1,621.81	$2,137.96