Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $251.19 / $257.04 / $346.74	Facility		$251.19	$257.04	$346.74
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $257.04 / $257.04 / $257.04	Facility	QZ	$257.04	$257.04	$257.04
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $120.23 / $660.69 / $1,096.48	Professional	AA	$120.23	$660.69	$1,096.48
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $89.13 / $323.59 / $562.34	Professional	QX	$89.13	$323.59	$562.34
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $239.88 / $302.00 / $478.63	Professional	QY	$239.88	$302.00	$478.63
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $123.03 / $575.44 / $977.24	Professional	QZ	$123.03	$575.44	$977.24
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $97.72 / $128.82 / $245.47	Professional	AA	$97.72	$128.82	$245.47
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $12.88 / $63.10 / $114.82	Professional	QX	$12.88	$63.10	$114.82
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $114.82 / $114.82 / $114.82	Professional	QY	$114.82	$114.82	$114.82
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $107.15 / $123.03 / $169.82	Professional	QZ	$107.15	$123.03	$169.82
BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $151.36 / $177.83 / $177.83	Professional	QX	$151.36	$177.83	$177.83
BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $288.40 / $338.84 / $338.84	Professional	QZ	$288.40	$338.84	$338.84
CareSource Facility/Professional Facility Modifier Low / Median / High Price $302.00 / $302.00 / $489.78	Facility		$302.00	$302.00	$489.78
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $257.04 / $257.04 / $338.84	Facility		$257.04	$257.04	$338.84
Health Alliance Plan Facility/Professional Facility Modifier QZ Low / Median / High Price $257.04 / $257.04 / $257.04	Facility	QZ	$257.04	$257.04	$257.04
Health Alliance Plan Facility/Professional Professional Modifier AA Low / Median / High Price $134.90 / $660.69 / $1,122.02	Professional	AA	$134.90	$660.69	$1,122.02
Health Alliance Plan Facility/Professional Professional Modifier QX Low / Median / High Price $67.61 / $346.74 / $562.34	Professional	QX	$67.61	$346.74	$562.34
Health Alliance Plan Facility/Professional Professional Modifier QY Low / Median / High Price $269.15 / $346.74 / $588.84	Professional	QY	$269.15	$346.74	$588.84
Health Alliance Plan Facility/Professional Professional Modifier QZ Low / Median / High Price $123.03 / $562.34 / $933.25	Professional	QZ	$123.03	$562.34	$933.25