Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,023.29 / $1,023.29 / $1,737.80	Facility		$1,023.29	$1,023.29	$1,737.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $912.01 / $1,096.48 / $1,737.80	Professional		$912.01	$1,096.48	$1,737.80
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,137.96 / $2,238.72 / $4,570.88	Facility		$2,137.96	$2,238.72	$4,570.88
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,621.81 / $2,137.96 / $3,235.94	Professional		$1,621.81	$2,137.96	$3,235.94
CareSource Facility/Professional Facility Modifier Low / Median / High Price $1,047.13 / $1,584.89 / $2,511.89	Facility		$1,047.13	$1,584.89	$2,511.89
CareSource Facility/Professional Professional Modifier Low / Median / High Price $1,348.96 / $1,862.09 / $2,818.38	Professional		$1,348.96	$1,862.09	$2,818.38
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,659.59 / $1,659.59 / $1,659.59	Facility		$1,659.59	$1,659.59	$1,659.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,412.54 / $1,412.54 / $1,659.59	Professional		$1,412.54	$1,412.54	$1,659.59
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $1,659.59 / $1,659.59 / $1,659.59	Facility		$1,659.59	$1,659.59	$1,659.59
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $1,412.54 / $1,412.54 / $1,659.59	Professional		$1,412.54	$1,412.54	$1,659.59
Molina Facility/Professional Professional Modifier Low / Median / High Price $1,659.59 / $2,344.23 / $3,388.44	Professional		$1,659.59	$2,344.23	$3,388.44
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $2,570.40 / $2,570.40 / $2,570.40	Facility		$2,570.40	$2,570.40	$2,570.40
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $2,137.96 / $2,630.27 / $4,365.16	Professional		$2,137.96	$2,630.27	$4,365.16
United Facility/Professional Facility Modifier Low / Median / High Price $912.01 / $2,137.96 / $2,290.87	Facility		$912.01	$2,137.96	$2,290.87
United Facility/Professional Professional Modifier Low / Median / High Price $691.83 / $1,288.25 / $2,137.96	Professional		$691.83	$1,288.25	$2,137.96