Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $933.25 / $933.25 / $1,778.28	Facility		$933.25	$933.25	$1,778.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $776.25 / $954.99 / $1,513.56	Professional		$776.25	$954.99	$1,513.56
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,949.84 / $2,041.74 / $4,168.69	Facility		$1,949.84	$2,041.74	$4,168.69
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $954.99 / $1,148.15 / $2,454.71	Professional		$954.99	$1,148.15	$2,454.71
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $1,621.81 / $1,621.81 / $1,621.81	Professional		$1,621.81	$1,621.81	$1,621.81
CareSource Facility/Professional Facility Modifier Low / Median / High Price $870.96 / $1,288.25 / $2,089.30	Facility		$870.96	$1,288.25	$2,089.30
CareSource Facility/Professional Professional Modifier Low / Median / High Price $1,122.02 / $1,548.82 / $2,344.23	Professional		$1,122.02	$1,548.82	$2,344.23
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,230.27 / $1,230.27 / $1,230.27	Facility		$1,230.27	$1,230.27	$1,230.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $891.25 / $891.25 / $1,230.27	Professional		$891.25	$891.25	$1,230.27
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $1,230.27 / $1,230.27 / $1,230.27	Facility		$1,230.27	$1,230.27	$1,230.27
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $891.25 / $891.25 / $1,148.15	Professional		$891.25	$891.25	$1,148.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $977.24 / $1,513.56 / $2,187.76	Professional		$977.24	$1,513.56	$2,187.76
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $2,344.23 / $2,344.23 / $2,344.23	Facility		$2,344.23	$2,344.23	$2,344.23
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $1,949.84 / $2,187.76 / $3,981.07	Professional		$1,949.84	$2,187.76	$3,981.07
United Facility/Professional Facility Modifier Low / Median / High Price $776.25 / $1,288.25 / $1,995.26	Facility		$776.25	$1,288.25	$1,995.26
United Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $954.99 / $1,318.26	Professional		$630.96	$954.99	$1,318.26