Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,949.84 / $1,949.84 / $3,311.31	Facility		$1,949.84	$1,949.84	$3,311.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,412.54 / $1,949.84 / $2,884.03	Professional		$1,412.54	$1,949.84	$2,884.03
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $4,073.80 / $4,265.80 / $8,709.64	Facility		$4,073.80	$4,265.80	$8,709.64
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,995.26 / $2,344.23 / $5,128.61	Professional		$1,995.26	$2,344.23	$5,128.61
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,621.81 / $2,454.71 / $3,890.45	Facility		$1,621.81	$2,454.71	$3,890.45
CareSource Facility/Professional Professional Modifier Low / Median / High Price $2,137.96 / $2,951.21 / $4,466.84	Professional		$2,137.96	$2,951.21	$4,466.84
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,691.53 / $2,691.53 / $2,691.53	Facility		$2,691.53	$2,691.53	$2,691.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,949.84 / $1,949.84 / $2,691.53	Professional		$1,949.84	$1,949.84	$2,691.53
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $2,691.53 / $2,691.53 / $2,691.53	Facility		$2,691.53	$2,691.53	$2,691.53
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $1,949.84 / $1,949.84 / $2,187.76	Professional		$1,949.84	$1,949.84	$2,187.76
Molina Facility/Professional Professional Modifier Low / Median / High Price $1,698.24 / $2,398.83 / $3,467.37	Professional		$1,698.24	$2,398.83	$3,467.37
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $4,786.30 / $4,786.30 / $4,786.30	Facility		$4,786.30	$4,786.30	$4,786.30
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $4,073.80 / $4,466.84 / $8,317.64	Professional		$4,073.80	$4,466.84	$8,317.64
United Facility/Professional Facility Modifier Low / Median / High Price $1,479.11 / $2,454.71 / $3,801.89	Facility		$1,479.11	$2,454.71	$3,801.89
United Facility/Professional Professional Modifier Low / Median / High Price $1,288.25 / $1,949.84 / $2,511.89	Professional		$1,288.25	$1,949.84	$2,511.89