Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,862.09 / $1,862.09 / $3,090.30	Facility		$1,862.09	$1,862.09	$3,090.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,412.54 / $1,862.09 / $2,884.03	Professional		$1,412.54	$1,862.09	$2,884.03
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,890.45 / $4,168.69 / $8,317.64	Facility		$3,890.45	$4,168.69	$8,317.64
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,905.46 / $2,290.87 / $5,011.87	Professional		$1,905.46	$2,290.87	$5,011.87
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,659.59 / $2,454.71 / $3,981.07	Facility		$1,659.59	$2,454.71	$3,981.07
CareSource Facility/Professional Professional Modifier Low / Median / High Price $2,137.96 / $2,951.21 / $4,466.84	Professional		$2,137.96	$2,951.21	$4,466.84
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,454.71 / $2,454.71 / $2,454.71	Facility		$2,454.71	$2,454.71	$2,454.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,819.70 / $1,819.70 / $2,454.71	Professional		$1,819.70	$1,819.70	$2,454.71
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $2,454.71 / $2,454.71 / $2,454.71	Facility		$2,454.71	$2,454.71	$2,454.71
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $1,819.70 / $1,819.70 / $2,187.76	Professional		$1,819.70	$1,819.70	$2,187.76
Molina Facility/Professional Professional Modifier Low / Median / High Price $1,659.59 / $2,344.23 / $3,388.44	Professional		$1,659.59	$2,344.23	$3,388.44
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $4,677.35 / $4,677.35 / $4,677.35	Facility		$4,677.35	$4,677.35	$4,677.35
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $3,890.45 / $4,365.16 / $8,128.31	Professional		$3,890.45	$4,365.16	$8,128.31
United Facility/Professional Facility Modifier Low / Median / High Price $1,479.11 / $2,511.89 / $3,801.89	Facility		$1,479.11	$2,511.89	$3,801.89
United Facility/Professional Professional Modifier Low / Median / High Price $1,288.25 / $1,905.46 / $2,570.40	Professional		$1,288.25	$1,905.46	$2,570.40