Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $302.00 / $309.03 / $436.52	Facility		$302.00	$309.03	$436.52
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $602.56 / $602.56 / $602.56	Facility	QZ	$602.56	$602.56	$602.56
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $512.86 / $851.14 / $1,412.54	Professional	AA	$512.86	$851.14	$1,412.54
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $173.78 / $389.05 / $707.95	Professional	QK	$173.78	$389.05	$707.95
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $154.88 / $380.19 / $691.83	Professional	QX	$154.88	$380.19	$691.83
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $239.88 / $363.08 / $691.83	Professional	QY	$239.88	$363.08	$691.83
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $281.84 / $537.03 / $1,288.25	Professional	QZ	$281.84	$537.03	$1,288.25
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $141.25 / $186.21 / $354.81	Professional	AA	$141.25	$186.21	$354.81
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $70.79 / $85.11 / $154.88	Professional	QK	$70.79	$85.11	$154.88
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $52.48 / $81.28 / $114.82	Professional	QX	$52.48	$81.28	$114.82
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $61.66 / $81.28 / $147.91	Professional	QY	$61.66	$81.28	$147.91
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $123.03 / $181.97 / $323.59	Professional	QZ	$123.03	$181.97	$323.59
BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $190.55 / $213.80 / $213.80	Professional	QX	$190.55	$213.80	$213.80
BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $363.08 / $407.38 / $407.38	Professional	QZ	$363.08	$407.38	$407.38
CareSource Facility/Professional Facility Modifier Low / Median / High Price $363.08 / $363.08 / $588.84	Facility		$363.08	$363.08	$588.84
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $302.00 / $309.03 / $416.87	Facility		$302.00	$309.03	$416.87
Health Alliance Plan Facility/Professional Professional Modifier AA Low / Median / High Price $501.19 / $831.76 / $1,412.54	Professional	AA	$501.19	$831.76	$1,412.54
Health Alliance Plan Facility/Professional Professional Modifier QK Low / Median / High Price $190.55 / $380.19 / $724.44	Professional	QK	$190.55	$380.19	$724.44
Health Alliance Plan Facility/Professional Professional Modifier QX Low / Median / High Price $169.82 / $389.05 / $707.95	Professional	QX	$169.82	$389.05	$707.95
Health Alliance Plan Facility/Professional Professional Modifier QY Low / Median / High Price $213.80 / $380.19 / $691.83	Professional	QY	$213.80	$380.19	$691.83
Health Alliance Plan Facility/Professional Professional Modifier QZ Low / Median / High Price $281.84 / $512.86 / $933.25	Professional	QZ	$281.84	$512.86	$933.25