Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $250.00 / $262.50 / $346.10	Facility		$250.00	$262.50	$346.10
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $255.75 / $255.75 / $255.75	Facility	QZ	$255.75	$255.75	$255.75
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $386.25 / $392.00 / $434.60	Professional	AA	$386.25	$392.00	$434.60
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $180.86 / $300.30 / $364.32	Professional	QX	$180.86	$300.30	$364.32
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $156.34 / $277.20 / $277.20	Professional	QY	$156.34	$277.20	$277.20
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $355.60 / $627.00 / $836.00	Professional	QZ	$355.60	$627.00	$836.00
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $127.62 / $127.62 / $127.62	Professional	AA	$127.62	$127.62	$127.62
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $74.45 / $79.76 / $126.56	Professional	QX	$74.45	$79.76	$126.56
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $120.36 / $127.62 / $127.62	Professional	QZ	$120.36	$127.62	$127.62
BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $78.31 / $179.15 / $203.40	Professional	QX	$78.31	$179.15	$203.40
BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $147.91 / $338.39 / $384.20	Professional	QZ	$147.91	$338.39	$384.20
CareSource Facility/Professional Facility Modifier Low / Median / High Price $301.35 / $494.90 / $494.90	Facility		$301.35	$494.90	$494.90
Cigna Facility/Professional Professional Modifier QX Low / Median / High Price $150.00 / $150.00 / $538.27	Professional	QX	$150.00	$150.00	$538.27
Cigna Facility/Professional Professional Modifier QY Low / Median / High Price $150.00 / $150.00 / $538.27	Professional	QY	$150.00	$150.00	$538.27
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $260.00 / $260.00 / $346.10	Facility		$260.00	$260.00	$346.10
Health Alliance Plan Facility/Professional Facility Modifier QZ Low / Median / High Price $255.75 / $255.75 / $255.75	Facility	QZ	$255.75	$255.75	$255.75
Health Alliance Plan Facility/Professional Professional Modifier AA Low / Median / High Price $386.25 / $392.00 / $434.60	Professional	AA	$386.25	$392.00	$434.60
Health Alliance Plan Facility/Professional Professional Modifier QX Low / Median / High Price $193.13 / $303.07 / $392.04	Professional	QX	$193.13	$303.07	$392.04
Health Alliance Plan Facility/Professional Professional Modifier QY Low / Median / High Price $156.34 / $277.20 / $277.20	Professional	QY	$156.34	$277.20	$277.20
Health Alliance Plan Facility/Professional Professional Modifier QZ Low / Median / High Price $355.60 / $504.00 / $836.00	Professional	QZ	$355.60	$504.00	$836.00