Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,348.96 / $1,348.96 / $2,290.87	Facility		$1,348.96	$1,348.96	$2,290.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,174.90 / $1,380.38 / $2,290.87	Professional		$1,174.90	$1,380.38	$2,290.87
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,818.38 / $2,951.21 / $6,025.60	Facility		$2,818.38	$2,951.21	$6,025.60
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,380.38 / $1,584.89 / $3,548.13	Professional		$1,380.38	$1,584.89	$3,548.13
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,380.38 / $2,089.30 / $3,311.31	Facility		$1,380.38	$2,089.30	$3,311.31
CareSource Facility/Professional Professional Modifier Low / Median / High Price $1,819.70 / $2,511.89 / $3,715.35	Professional		$1,819.70	$2,511.89	$3,715.35
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,778.28 / $1,778.28 / $1,778.28	Facility		$1,778.28	$1,778.28	$1,778.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,318.26 / $1,318.26 / $1,778.28	Professional		$1,318.26	$1,318.26	$1,778.28
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $1,778.28 / $1,778.28 / $1,778.28	Facility		$1,778.28	$1,778.28	$1,778.28
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $1,318.26 / $1,318.26 / $1,778.28	Professional		$1,318.26	$1,318.26	$1,778.28
Molina Facility/Professional Professional Modifier Low / Median / High Price $1,513.56 / $2,398.83 / $3,467.37	Professional		$1,513.56	$2,398.83	$3,467.37
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $3,388.44 / $3,388.44 / $3,388.44	Facility		$3,388.44	$3,388.44	$3,388.44
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $2,818.38 / $3,162.28 / $5,754.40	Professional		$2,818.38	$3,162.28	$5,754.40
United Facility/Professional Facility Modifier Low / Median / High Price $1,023.29 / $1,862.09 / $2,884.03	Facility		$1,023.29	$1,862.09	$2,884.03
United Facility/Professional Professional Modifier Low / Median / High Price $912.01 / $1,380.38 / $1,905.46	Professional		$912.01	$1,380.38	$1,905.46