Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,187.76 / $2,187.76 / $3,715.35	Facility		$2,187.76	$2,187.76	$3,715.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,905.46 / $2,238.72 / $3,715.35	Professional		$1,905.46	$2,238.72	$3,715.35
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $3,388.44 / $3,388.44 / $3,388.44	Professional		$3,388.44	$3,388.44	$3,388.44
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $4,570.88 / $4,786.30 / $9,772.37	Facility		$4,570.88	$4,786.30	$9,772.37
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,238.72 / $2,754.23 / $5,754.40	Professional		$2,238.72	$2,754.23	$5,754.40
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $3,801.89 / $3,801.89 / $3,801.89	Professional		$3,801.89	$3,801.89	$3,801.89
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2,238.72 / $3,388.44 / $5,370.32	Facility		$2,238.72	$3,388.44	$5,370.32
CareSource Facility/Professional Professional Modifier Low / Median / High Price $2,951.21 / $4,073.80 / $6,025.60	Professional		$2,951.21	$4,073.80	$6,025.60
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,511.89 / $2,511.89 / $2,511.89	Facility		$2,511.89	$2,511.89	$2,511.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,819.70 / $1,819.70 / $2,511.89	Professional		$1,819.70	$1,819.70	$2,511.89
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $2,511.89 / $2,511.89 / $2,511.89	Facility		$2,511.89	$2,511.89	$2,511.89
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $1,819.70 / $1,819.70 / $2,511.89	Professional		$1,819.70	$1,819.70	$2,511.89
Molina Facility/Professional Professional Modifier Low / Median / High Price $1,949.84 / $2,754.23 / $3,890.45	Professional		$1,949.84	$2,754.23	$3,890.45
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $5,495.41 / $5,495.41 / $5,495.41	Facility		$5,495.41	$5,495.41	$5,495.41
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $4,570.88 / $5,128.61 / $9,332.54	Professional		$4,570.88	$5,128.61	$9,332.54
United Facility/Professional Facility Modifier Low / Median / High Price $1,659.59 / $3,019.95 / $4,677.35	Facility		$1,659.59	$3,019.95	$4,677.35
United Facility/Professional Professional Modifier Low / Median / High Price $1,479.11 / $2,238.72 / $3,090.30	Professional		$1,479.11	$2,238.72	$3,090.30