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 / $2,511.89	Facility		$1,479.11	$1,479.11	$2,511.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,288.25 / $1,513.56 / $2,454.71	Professional		$1,288.25	$1,513.56	$2,454.71
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 $1,513.56 / $1,819.70 / $3,890.45	Professional		$1,513.56	$1,819.70	$3,890.45
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $2,570.40 / $2,570.40 / $2,570.40	Professional		$2,570.40	$2,570.40	$2,570.40
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,513.56 / $2,290.87 / $3,630.78	Facility		$1,513.56	$2,290.87	$3,630.78
CareSource Facility/Professional Professional Modifier Low / Median / High Price $1,995.26 / $2,754.23 / $4,073.80	Professional		$1,995.26	$2,754.23	$4,073.80
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,949.84 / $1,949.84 / $1,949.84	Facility		$1,949.84	$1,949.84	$1,949.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,412.54 / $1,412.54 / $1,949.84	Professional		$1,412.54	$1,412.54	$1,949.84
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $1,949.84 / $1,949.84 / $1,949.84	Facility		$1,949.84	$1,949.84	$1,949.84
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $1,412.54 / $1,412.54 / $1,949.84	Professional		$1,412.54	$1,412.54	$1,949.84
Molina Facility/Professional Professional Modifier Low / Median / High Price $1,659.59 / $2,570.40 / $3,801.89	Professional		$1,659.59	$2,570.40	$3,801.89
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 $1,122.02 / $2,041.74 / $3,090.30	Facility		$1,122.02	$2,041.74	$3,090.30
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