Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,238.72 / $2,238.72 / $3,801.89	Facility		$2,238.72	$2,238.72	$3,801.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,949.84 / $2,238.72 / $3,715.35	Professional		$1,949.84	$2,238.72	$3,715.35
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $4,677.35 / $4,897.79 / $10,000.00	Facility		$4,677.35	$4,897.79	$10,000.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,949.84 / $2,570.40 / $5,888.44	Professional		$1,949.84	$2,570.40	$5,888.44
CareSource Facility/Professional Facility Modifier Low / Median / High Price $2,290.87 / $3,467.37 / $5,495.41	Facility		$2,290.87	$3,467.37	$5,495.41
CareSource Facility/Professional Professional Modifier Low / Median / High Price $2,951.21 / $4,073.80 / $6,165.95	Professional		$2,951.21	$4,073.80	$6,165.95
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,951.21 / $2,951.21 / $2,951.21	Facility		$2,951.21	$2,951.21	$2,951.21
Cigna Facility/Professional Professional Modifier Low / Median / High Price $2,137.96 / $2,137.96 / $2,951.21	Professional		$2,137.96	$2,137.96	$2,951.21
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $2,951.21 / $2,951.21 / $2,951.21	Facility		$2,951.21	$2,951.21	$2,951.21
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $2,137.96 / $2,137.96 / $2,951.21	Professional		$2,137.96	$2,137.96	$2,951.21
Molina Facility/Professional Professional Modifier Low / Median / High Price $2,511.89 / $3,890.45 / $5,623.41	Professional		$2,511.89	$3,890.45	$5,623.41
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $5,623.41 / $5,623.41 / $5,623.41	Facility		$5,623.41	$5,623.41	$5,623.41
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $4,677.35 / $5,248.07 / $9,549.93	Professional		$4,677.35	$5,248.07	$9,549.93
United Facility/Professional Facility Modifier Low / Median / High Price $1,698.24 / $3,019.95 / $4,677.35	Facility		$1,698.24	$3,019.95	$4,677.35
United Facility/Professional Professional Modifier Low / Median / High Price $1,513.56 / $2,238.72 / $3,090.30	Professional		$1,513.56	$2,238.72	$3,090.30