Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,737.80 / $1,737.80 / $2,818.38	Facility		$1,737.80	$1,737.80	$2,818.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,258.93 / $1,737.80 / $2,511.89	Professional		$1,258.93	$1,737.80	$2,511.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $3,548.13 / $3,548.13 / $3,548.13	Professional		$3,548.13	$3,548.13	$3,548.13
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,630.78 / $3,801.89 / $7,762.47	Facility		$3,630.78	$3,801.89	$7,762.47
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,737.80 / $2,041.74 / $4,570.88	Professional		$1,737.80	$2,041.74	$4,570.88
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 $2,290.87 / $2,290.87 / $2,290.87	Facility		$2,290.87	$2,290.87	$2,290.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,659.59 / $1,659.59 / $2,290.87	Professional		$1,659.59	$1,659.59	$2,290.87
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $2,290.87 / $2,290.87 / $2,290.87	Facility		$2,290.87	$2,290.87	$2,290.87
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $1,659.59 / $1,659.59 / $1,949.84	Professional		$1,659.59	$1,659.59	$1,949.84
Molina Facility/Professional Professional Modifier Low / Median / High Price $1,862.09 / $2,630.27 / $3,801.89	Professional		$1,862.09	$2,630.27	$3,801.89
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $4,365.16 / $4,365.16 / $4,365.16	Facility		$4,365.16	$4,365.16	$4,365.16
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $3,630.78 / $4,073.80 / $7,413.10	Professional		$3,630.78	$4,073.80	$7,413.10
United Facility/Professional Facility Modifier Low / Median / High Price $1,288.25 / $2,187.76 / $3,311.31	Facility		$1,288.25	$2,187.76	$3,311.31
United Facility/Professional Professional Modifier Low / Median / High Price $1,122.02 / $1,737.80 / $2,238.72	Professional		$1,122.02	$1,737.80	$2,238.72