Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,174.90 / $1,174.90 / $2,089.30	Facility		$1,174.90	$1,174.90	$2,089.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $977.24 / $1,230.27 / $1,995.26	Professional		$977.24	$1,230.27	$1,995.26
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,454.71 / $2,570.40 / $5,248.07	Facility		$2,454.71	$2,570.40	$5,248.07
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,174.90 / $1,412.54 / $3,090.30	Professional		$1,174.90	$1,412.54	$3,090.30
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,148.15 / $1,698.24 / $2,754.23	Facility		$1,148.15	$1,698.24	$2,754.23
CareSource Facility/Professional Professional Modifier Low / Median / High Price $1,479.11 / $2,041.74 / $3,090.30	Professional		$1,479.11	$2,041.74	$3,090.30
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,659.59 / $1,659.59 / $1,659.59	Facility		$1,659.59	$1,659.59	$1,659.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,202.26 / $1,202.26 / $1,659.59	Professional		$1,202.26	$1,202.26	$1,659.59
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $1,659.59 / $1,659.59 / $1,659.59	Facility		$1,659.59	$1,659.59	$1,659.59
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $1,202.26 / $1,202.26 / $1,659.59	Professional		$1,202.26	$1,202.26	$1,659.59
Molina Facility/Professional Professional Modifier Low / Median / High Price $1,047.13 / $1,479.11 / $2,089.30	Professional		$1,047.13	$1,479.11	$2,089.30
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $2,951.21 / $2,951.21 / $2,951.21	Facility		$2,951.21	$2,951.21	$2,951.21
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $2,454.71 / $2,754.23 / $5,011.87	Professional		$2,454.71	$2,754.23	$5,011.87
United Facility/Professional Facility Modifier Low / Median / High Price $1,023.29 / $1,698.24 / $2,630.27	Facility		$1,023.29	$1,698.24	$2,630.27
United Facility/Professional Professional Modifier Low / Median / High Price $794.33 / $1,202.26 / $1,737.80	Professional		$794.33	$1,202.26	$1,737.80