Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $776.25 / $776.25 / $1,318.26	Facility		$776.25	$776.25	$1,318.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $676.08 / $794.33 / $1,288.25	Professional		$676.08	$794.33	$1,288.25
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,621.81 / $1,698.24 / $3,467.37	Facility		$1,621.81	$1,698.24	$3,467.37
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $794.33 / $977.24 / $2,041.74	Professional		$794.33	$977.24	$2,041.74
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $1,348.96 / $1,348.96 / $1,348.96	Professional		$1,348.96	$1,348.96	$1,348.96
CareSource Facility/Professional Facility Modifier Low / Median / High Price $794.33 / $1,202.26 / $1,905.46	Facility		$794.33	$1,202.26	$1,905.46
CareSource Facility/Professional Professional Modifier Low / Median / High Price $1,047.13 / $1,445.44 / $2,137.96	Professional		$1,047.13	$1,445.44	$2,137.96
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,122.02 / $1,122.02 / $1,122.02	Facility		$1,122.02	$1,122.02	$1,122.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $812.83 / $812.83 / $1,122.02	Professional		$812.83	$812.83	$1,122.02
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $1,122.02 / $1,122.02 / $1,122.02	Facility		$1,122.02	$1,122.02	$1,122.02
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $812.83 / $812.83 / $1,122.02	Professional		$812.83	$812.83	$1,122.02
Molina Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $1,348.96 / $1,995.26	Professional		$870.96	$1,348.96	$1,995.26
SummaCare 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
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $1,621.81 / $1,819.70 / $3,311.31	Professional		$1,621.81	$1,819.70	$3,311.31
United Facility/Professional Facility Modifier Low / Median / High Price $588.84 / $1,071.52 / $1,621.81	Facility		$588.84	$1,071.52	$1,621.81
United Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $776.25 / $1,096.48	Professional		$524.81	$776.25	$1,096.48