Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,479.11 / $1,479.11 / $3,090.30	Facility		$1,479.11	$1,479.11	$3,090.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,174.90 / $1,479.11 / $2,398.83	Professional		$1,174.90	$1,479.11	$2,398.83
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,090.30 / $3,235.94 / $6,606.93	Facility		$3,090.30	$3,235.94	$6,606.93
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,479.11 / $1,698.24 / $3,890.45	Professional		$1,479.11	$1,698.24	$3,890.45
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,380.38 / $2,041.74 / $3,311.31	Facility		$1,380.38	$2,041.74	$3,311.31
CareSource Facility/Professional Professional Modifier Low / Median / High Price $1,778.28 / $2,454.71 / $3,715.35	Professional		$1,778.28	$2,454.71	$3,715.35
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,698.24 / $1,698.24 / $1,698.24	Facility		$1,698.24	$1,698.24	$1,698.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,258.93 / $1,258.93 / $1,698.24	Professional		$1,258.93	$1,258.93	$1,698.24
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $1,698.24 / $1,698.24 / $1,698.24	Facility		$1,698.24	$1,698.24	$1,698.24
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $1,258.93 / $1,258.93 / $1,698.24	Professional		$1,258.93	$1,258.93	$1,698.24
Molina Facility/Professional Professional Modifier Low / Median / High Price $1,318.26 / $1,819.70 / $2,630.27	Professional		$1,318.26	$1,819.70	$2,630.27
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $3,715.35 / $3,715.35 / $3,715.35	Facility		$3,715.35	$3,715.35	$3,715.35
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $3,090.30 / $3,467.37 / $6,309.57	Professional		$3,090.30	$3,467.37	$6,309.57
United Facility/Professional Facility Modifier Low / Median / High Price $1,148.15 / $2,041.74 / $3,162.28	Facility		$1,148.15	$2,041.74	$3,162.28
United Facility/Professional Professional Modifier Low / Median / High Price $1,000.00 / $1,479.11 / $2,089.30	Professional		$1,000.00	$1,479.11	$2,089.30