Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $3,715.35 / $3,715.35 / $4,365.16	Facility		$3,715.35	$3,715.35	$4,365.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $3,715.35 / $3,715.35 / $4,073.80	Professional		$3,715.35	$3,715.35	$4,073.80
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $3,715.35 / $6,309.57	Professional		$199.53	$3,715.35	$6,309.57
CareSource Facility/Professional Facility Modifier Low / Median / High Price $3,715.35 / $3,715.35 / $3,715.35	Facility		$3,715.35	$3,715.35	$3,715.35
CareSource Facility/Professional Professional Modifier Low / Median / High Price $3,715.35 / $3,715.35 / $5,011.87	Professional		$3,715.35	$3,715.35	$5,011.87
Cigna Facility/Professional Facility Modifier Low / Median / High Price $3,467.37 / $3,467.37 / $3,715.35	Facility		$3,467.37	$3,467.37	$3,715.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $3,715.35 / $3,715.35 / $3,801.89	Professional		$3,715.35	$3,715.35	$3,801.89
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $3,467.37 / $3,467.37 / $3,715.35	Facility		$3,467.37	$3,467.37	$3,715.35
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $3,715.35 / $3,715.35 / $4,897.79	Professional		$3,715.35	$3,715.35	$4,897.79
Molina Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $60.26 / $4,073.80	Professional		$39.81	$60.26	$4,073.80
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 $123.03 / $144.54 / $4,168.69	Professional		$123.03	$144.54	$4,168.69
United Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $2,818.38 / $2,951.21	Professional		$125.89	$2,818.38	$2,951.21