Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,630.27 / $2,630.27 / $3,801.89	Facility		$2,630.27	$2,630.27	$3,801.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,862.09 / $2,630.27 / $3,715.35	Professional		$1,862.09	$2,630.27	$3,715.35
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $5,495.41 / $5,888.44 / $11,748.98	Facility		$5,495.41	$5,888.44	$11,748.98
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,691.53 / $3,235.94 / $7,079.46	Professional		$2,691.53	$3,235.94	$7,079.46
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 $2,818.38 / $3,890.45 / $5,888.44	Professional		$2,818.38	$3,890.45	$5,888.44
Cigna Facility/Professional Facility Modifier Low / Median / High Price $3,548.13 / $3,548.13 / $3,548.13	Facility		$3,548.13	$3,548.13	$3,548.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $2,570.40 / $2,570.40 / $3,548.13	Professional		$2,570.40	$2,570.40	$3,548.13
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $3,548.13 / $3,548.13 / $3,548.13	Facility		$3,548.13	$3,548.13	$3,548.13
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $2,570.40 / $2,570.40 / $3,548.13	Professional		$2,570.40	$2,570.40	$3,548.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $2,344.23 / $3,311.31 / $4,786.30	Professional		$2,344.23	$3,311.31	$4,786.30
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $6,606.93 / $6,606.93 / $6,606.93	Facility		$6,606.93	$6,606.93	$6,606.93
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $5,495.41 / $6,165.95 / $11,481.54	Professional		$5,495.41	$6,165.95	$11,481.54
United Facility/Professional Facility Modifier Low / Median / High Price $1,949.84 / $3,311.31 / $5,011.87	Facility		$1,949.84	$3,311.31	$5,011.87
United Facility/Professional Professional Modifier Low / Median / High Price $1,698.24 / $2,691.53 / $3,467.37	Professional		$1,698.24	$2,691.53	$3,467.37