Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $300.00 / $315.00 / $415.32	Facility		$300.00	$315.00	$415.32
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $498.00 / $723.36 / $1,108.80	Professional	AA	$498.00	$723.36	$1,108.80
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $224.25 / $369.60 / $522.34	Professional	QK	$224.25	$369.60	$522.34
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $187.00 / $311.85 / $490.05	Professional	QX	$187.00	$311.85	$490.05
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $171.67 / $323.39 / $393.19	Professional	QY	$171.67	$323.39	$393.19
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $279.30 / $355.60 / $432.00	Professional	QZ	$279.30	$355.60	$432.00
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $141.75 / $221.21 / $430.72	Professional	AA	$141.75	$221.21	$430.72
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $60.75 / $85.08 / $138.53	Professional	QK	$60.75	$85.08	$138.53
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $63.81 / $85.08 / $119.64	Professional	QX	$63.81	$85.08	$119.64
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $70.20 / $75.93 / $91.13	Professional	QY	$70.20	$75.93	$91.13
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $121.50 / $162.00 / $243.00	Professional	QZ	$121.50	$162.00	$243.00
BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $97.90 / $214.97 / $254.25	Professional	QX	$97.90	$214.97	$254.25
BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $184.90 / $406.06 / $480.25	Professional	QZ	$184.90	$406.06	$480.25
CareSource Facility/Professional Facility Modifier Low / Median / High Price $361.62 / $593.88 / $593.88	Facility		$361.62	$593.88	$593.88
Cigna Facility/Professional Professional Modifier QK Low / Median / High Price $180.00 / $180.00 / $566.60	Professional	QK	$180.00	$180.00	$566.60
Cigna Facility/Professional Professional Modifier QX Low / Median / High Price $180.00 / $180.00 / $566.60	Professional	QX	$180.00	$180.00	$566.60
Cigna Facility/Professional Professional Modifier QY Low / Median / High Price $180.00 / $180.00 / $566.60	Professional	QY	$180.00	$180.00	$566.60
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $312.00 / $312.00 / $415.32	Facility		$312.00	$312.00	$415.32
Health Alliance Plan Facility/Professional Professional Modifier AA Low / Median / High Price $566.10 / $813.78 / $1,108.80	Professional	AA	$566.10	$813.78	$1,108.80
Health Alliance Plan Facility/Professional Professional Modifier QK Low / Median / High Price $250.25 / $353.87 / $522.34	Professional	QK	$250.25	$353.87	$522.34
Health Alliance Plan Facility/Professional Professional Modifier QX Low / Median / High Price $178.50 / $340.95 / $503.69	Professional	QX	$178.50	$340.95	$503.69
Health Alliance Plan Facility/Professional Professional Modifier QY Low / Median / High Price $199.26 / $330.33 / $397.98	Professional	QY	$199.26	$330.33	$397.98
Health Alliance Plan Facility/Professional Professional Modifier QZ Low / Median / High Price $279.30 / $355.60 / $504.00	Professional	QZ	$279.30	$355.60	$504.00
United Facility/Professional Professional Modifier AA Low / Median / High Price $1,445.60 / $1,445.60 / $1,445.60	Professional	AA	$1,445.60	$1,445.60	$1,445.60
United Facility/Professional Professional Modifier QY Low / Median / High Price $189.00 / $189.00 / $189.00	Professional	QY	$189.00	$189.00	$189.00