Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $19.05 / $19.05 / $22.91	Facility		$19.05	$19.05	$22.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $19.05 / $19.05 / $22.91	Professional		$19.05	$19.05	$22.91
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $23.99 / $117.49	Professional		$19.95	$23.99	$117.49
CareSource Facility/Professional Facility Modifier Low / Median / High Price $19.95 / $19.95 / $19.95	Facility		$19.95	$19.95	$19.95
CareSource Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $19.95 / $26.92	Professional		$19.95	$19.95	$26.92
Cigna Facility/Professional Facility Modifier Low / Median / High Price $19.05 / $19.05 / $19.95	Facility		$19.05	$19.05	$19.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $19.95 / $26.92	Professional		$19.95	$19.95	$26.92
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $19.05 / $19.05 / $19.95	Facility		$19.05	$19.05	$19.95
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $19.95 / $28.18	Professional		$19.95	$19.95	$28.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $50.12 / $102.33	Professional		$21.88	$50.12	$102.33
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 $47.86 / $134.90 / $269.15	Professional		$47.86	$134.90	$269.15
United Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $22.39 / $125.89	Professional		$21.38	$22.39	$125.89