Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,819.70 / $1,819.70 / $3,090.30	Facility		$1,819.70	$1,819.70	$3,090.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,584.89 / $1,862.09 / $3,090.30	Professional		$1,584.89	$1,862.09	$3,090.30
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,801.89 / $4,073.80 / $8,128.31	Facility		$3,801.89	$4,073.80	$8,128.31
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,862.09 / $2,290.87 / $4,786.30	Professional		$1,862.09	$2,290.87	$4,786.30
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $3,162.28 / $3,162.28 / $3,162.28	Professional		$3,162.28	$3,162.28	$3,162.28
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,862.09 / $2,818.38 / $4,466.84	Facility		$1,862.09	$2,818.38	$4,466.84
CareSource Facility/Professional Professional Modifier Low / Median / High Price $2,454.71 / $3,388.44 / $5,128.61	Professional		$2,454.71	$3,388.44	$5,128.61
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,290.87 / $2,290.87 / $2,290.87	Facility		$2,290.87	$2,290.87	$2,290.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,659.59 / $1,659.59 / $2,290.87	Professional		$1,659.59	$1,659.59	$2,290.87
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $2,290.87 / $2,290.87 / $2,290.87	Facility		$2,290.87	$2,290.87	$2,290.87
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $1,659.59 / $1,659.59 / $2,290.87	Professional		$1,659.59	$1,659.59	$2,290.87
Molina Facility/Professional Professional Modifier Low / Median / High Price $2,041.74 / $3,235.94 / $4,677.35	Professional		$2,041.74	$3,235.94	$4,677.35
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $4,570.88 / $4,570.88 / $4,570.88	Facility		$4,570.88	$4,570.88	$4,570.88
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $3,801.89 / $4,265.80 / $7,943.28	Professional		$3,801.89	$4,265.80	$7,943.28
United Facility/Professional Facility Modifier Low / Median / High Price $1,380.38 / $2,511.89 / $3,890.45	Facility		$1,380.38	$2,511.89	$3,890.45
United Facility/Professional Professional Modifier Low / Median / High Price $1,258.93 / $1,862.09 / $2,570.40	Professional		$1,258.93	$1,862.09	$2,570.40