Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $77.62 / $91.20	Facility		$77.62	$77.62	$91.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $77.62 / $91.20	Professional		$77.62	$77.62	$91.20
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $93.33 / $162.18	Professional		$77.62	$93.33	$162.18
CareSource Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $77.62 / $77.62	Facility		$77.62	$77.62	$77.62
CareSource Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $77.62 / $104.71	Professional		$77.62	$77.62	$104.71
Cigna Facility/Professional Facility Modifier Low / Median / High Price $74.13 / $74.13 / $77.62	Facility		$74.13	$74.13	$77.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $77.62 / $85.11	Professional		$77.62	$77.62	$85.11
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $74.13 / $74.13 / $77.62	Facility		$74.13	$74.13	$77.62
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $77.62 / $107.15	Professional		$77.62	$77.62	$107.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $97.72 / $131.83	Professional		$79.43	$97.72	$131.83
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $144.54 / $158.49	Facility		$134.90	$144.54	$158.49
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $134.90 / $269.15	Professional		$114.82	$134.90	$269.15
United Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $83.18 / $125.89	Professional		$77.62	$83.18	$125.89