Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,819.70 / $1,819.70 / $3,388.44	Facility		$1,819.70	$1,819.70	$3,388.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,445.44 / $1,819.70 / $2,951.21	Professional		$1,445.44	$1,819.70	$2,951.21
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $2,570.40 / $2,630.27 / $3,548.13	Professional		$2,570.40	$2,630.27	$3,548.13
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,801.89 / $3,981.07 / $8,128.31	Facility		$3,801.89	$3,981.07	$8,128.31
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,819.70 / $2,187.76 / $4,786.30	Professional		$1,819.70	$2,187.76	$4,786.30
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $3,162.28 / $3,162.28 / $3,162.28	Professional		$3,162.28	$3,162.28	$3,162.28
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,737.80 / $2,570.40 / $4,168.69	Facility		$1,737.80	$2,570.40	$4,168.69
CareSource Facility/Professional Professional Modifier Low / Median / High Price $2,238.72 / $3,090.30 / $4,677.35	Professional		$2,238.72	$3,090.30	$4,677.35
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,398.83 / $2,398.83 / $2,398.83	Facility		$2,398.83	$2,398.83	$2,398.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,737.80 / $1,737.80 / $2,398.83	Professional		$1,737.80	$1,737.80	$2,398.83
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $2,398.83 / $2,398.83 / $2,398.83	Facility		$2,398.83	$2,398.83	$2,398.83
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $1,737.80 / $1,737.80 / $2,290.87	Professional		$1,737.80	$1,737.80	$2,290.87
Molina Facility/Professional Professional Modifier Low / Median / High Price $2,041.74 / $2,884.03 / $4,168.69	Professional		$2,041.74	$2,884.03	$4,168.69
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $4,570.88 / $4,570.88 / $4,570.88	Facility		$4,570.88	$4,570.88	$4,570.88
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $3,801.89 / $4,265.80 / $7,762.47	Professional		$3,801.89	$4,265.80	$7,762.47
United Facility/Professional Facility Modifier Low / Median / High Price $1,380.38 / $2,454.71 / $3,801.89	Facility		$1,380.38	$2,454.71	$3,801.89
United Facility/Professional Professional Modifier Low / Median / High Price $1,230.27 / $1,819.70 / $2,511.89	Professional		$1,230.27	$1,819.70	$2,511.89