Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $891.25 / $1,513.56 / $3,019.95	Facility		$891.25	$1,513.56	$3,019.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $776.25 / $912.01 / $1,513.56	Professional		$776.25	$912.01	$1,513.56
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,862.09 / $1,949.84 / $3,981.07	Facility		$1,862.09	$1,949.84	$3,981.07
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $831.76 / $1,174.90 / $2,398.83	Professional		$831.76	$1,174.90	$2,398.83
CareSource Facility/Professional Facility Modifier Low / Median / High Price $912.01 / $1,380.38 / $2,187.76	Facility		$912.01	$1,380.38	$2,187.76
CareSource Facility/Professional Professional Modifier Low / Median / High Price $1,202.26 / $1,659.59 / $2,511.89	Professional		$1,202.26	$1,659.59	$2,511.89
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,023.29 / $1,023.29 / $1,023.29	Facility		$1,023.29	$1,023.29	$1,023.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $870.96 / $1,023.29	Professional		$870.96	$870.96	$1,023.29
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $1,023.29 / $1,023.29 / $1,023.29	Facility		$1,023.29	$1,023.29	$1,023.29
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $870.96 / $1,023.29	Professional		$870.96	$870.96	$1,023.29
Molina Facility/Professional Professional Modifier Low / Median / High Price $1,000.00 / $1,584.89 / $2,290.87	Professional		$1,000.00	$1,584.89	$2,290.87
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $2,238.72 / $2,238.72 / $2,238.72	Facility		$2,238.72	$2,238.72	$2,238.72
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $1,862.09 / $2,089.30 / $3,890.45	Professional		$1,862.09	$2,089.30	$3,890.45
United Facility/Professional Facility Modifier Low / Median / High Price $676.08 / $1,230.27 / $1,905.46	Facility		$676.08	$1,230.27	$1,905.46
United Facility/Professional Professional Modifier Low / Median / High Price $602.56 / $912.01 / $1,288.25	Professional		$602.56	$912.01	$1,288.25