Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $676.08 / $1,230.27	Facility		$134.90	$676.08	$1,230.27
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $436.52 / $436.52 / $891.25	Facility	QZ	$436.52	$436.52	$891.25
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $467.74 / $812.83 / $1,412.54	Professional	AA	$467.74	$812.83	$1,412.54
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $181.97 / $338.84 / $549.54	Professional	QK	$181.97	$338.84	$549.54
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $204.17 / $338.84 / $575.44	Professional	QX	$204.17	$338.84	$575.44
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $239.88 / $316.23 / $501.19	Professional	QY	$239.88	$316.23	$501.19
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $281.84 / $549.54 / $724.44	Professional	QZ	$281.84	$549.54	$724.44
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $138.04 / $162.18 / $218.78	Professional	AA	$138.04	$162.18	$218.78
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $60.26 / $72.44 / $117.49	Professional	QK	$60.26	$72.44	$117.49
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $57.54 / $81.28 / $114.82	Professional	QX	$57.54	$81.28	$114.82
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $57.54 / $72.44 / $109.65	Professional	QY	$57.54	$72.44	$109.65
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $117.49 / $147.91 / $223.87	Professional	QZ	$117.49	$147.91	$223.87
Anthem BCBS Facility/Professional Professional Modifier AA Low / Median / High Price $309.03 / $309.03 / $309.03	Professional	AA	$309.03	$309.03	$309.03
Aultcare Facility/Professional Professional Modifier AA Low / Median / High Price $288.40 / $389.05 / $549.54	Professional	AA	$288.40	$389.05	$549.54
Aultcare Facility/Professional Professional Modifier QK Low / Median / High Price $128.82 / $181.97 / $223.87	Professional	QK	$128.82	$181.97	$223.87
Aultcare Facility/Professional Professional Modifier QX Low / Median / High Price $169.82 / $204.17 / $234.42	Professional	QX	$169.82	$204.17	$234.42
Aultcare Facility/Professional Professional Modifier QY Low / Median / High Price $218.78 / $223.87 / $245.47	Professional	QY	$218.78	$223.87	$245.47
Aultcare Facility/Professional Professional Modifier QZ Low / Median / High Price $302.00 / $323.59 / $446.68	Professional	QZ	$302.00	$323.59	$446.68
CareSource Facility/Professional Facility Modifier Low / Median / High Price $47.86 / $77.62 / $213.80	Facility		$47.86	$77.62	$213.80
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $16.98 / $213.80 / $977.24	Facility		$16.98	$213.80	$977.24
Medical Mutual of Ohio Facility/Professional Professional Modifier QK Low / Median / High Price $22.39 / $70.79 / $331.13	Professional	QK	$22.39	$70.79	$331.13
Medical Mutual of Ohio Facility/Professional Professional Modifier QX Low / Median / High Price $53.70 / $109.65 / $331.13	Professional	QX	$53.70	$109.65	$331.13
Medical Mutual of Ohio Facility/Professional Professional Modifier QY Low / Median / High Price $53.70 / $89.13 / $331.13	Professional	QY	$53.70	$89.13	$331.13
SummaCare Facility/Professional Professional Modifier QK Low / Median / High Price $112.20 / $162.18 / $169.82	Professional	QK	$112.20	$162.18	$169.82
SummaCare Facility/Professional Professional Modifier QX Low / Median / High Price $125.89 / $162.18 / $190.55	Professional	QX	$125.89	$162.18	$190.55
SummaCare Facility/Professional Professional Modifier QY Low / Median / High Price $138.04 / $162.18 / $208.93	Professional	QY	$138.04	$162.18	$208.93