Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,137.96 / $2,137.96 / $3,630.78	Facility		$2,137.96	$2,137.96	$3,630.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,862.09 / $2,187.76 / $3,630.78	Professional		$1,862.09	$2,187.76	$3,630.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $2,454.71 / $3,235.94 / $3,548.13	Professional		$2,454.71	$3,235.94	$3,548.13
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $4,466.84 / $4,677.35 / $9,549.93	Facility		$4,466.84	$4,677.35	$9,549.93
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,187.76 / $2,691.53 / $5,754.40	Professional		$2,187.76	$2,691.53	$5,754.40
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $3,715.35 / $3,715.35 / $3,715.35	Professional		$3,715.35	$3,715.35	$3,715.35
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2,187.76 / $3,311.31 / $5,248.07	Facility		$2,187.76	$3,311.31	$5,248.07
CareSource Facility/Professional Professional Modifier Low / Median / High Price $2,884.03 / $3,981.07 / $5,888.44	Professional		$2,884.03	$3,981.07	$5,888.44
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,454.71 / $2,454.71 / $2,454.71	Facility		$2,454.71	$2,454.71	$2,454.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,778.28 / $1,778.28 / $2,454.71	Professional		$1,778.28	$1,778.28	$2,454.71
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $2,454.71 / $2,454.71 / $2,454.71	Facility		$2,454.71	$2,454.71	$2,454.71
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $1,778.28 / $1,778.28 / $2,454.71	Professional		$1,778.28	$1,778.28	$2,454.71
Molina Facility/Professional Professional Modifier Low / Median / High Price $2,398.83 / $3,388.44 / $4,786.30	Professional		$2,398.83	$3,388.44	$4,786.30
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $5,370.32 / $5,370.32 / $5,370.32	Facility		$5,370.32	$5,370.32	$5,370.32
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $4,466.84 / $5,011.87 / $9,120.11	Professional		$4,466.84	$5,011.87	$9,120.11
United Facility/Professional Facility Modifier Low / Median / High Price $1,621.81 / $2,951.21 / $4,570.88	Facility		$1,621.81	$2,951.21	$4,570.88
United Facility/Professional Professional Modifier Low / Median / High Price $1,445.44 / $2,187.76 / $3,019.95	Professional		$1,445.44	$2,187.76	$3,019.95