Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $97.08 / $598.14 / $967.22	Facility		$97.08	$598.14	$967.22
Aetna Facility/Professional Facility Modifier QX Low / Median / High Price $78.08 / $78.08 / $78.08	Facility	QX	$78.08	$78.08	$78.08
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $434.00 / $434.00 / $892.16	Facility	QZ	$434.00	$434.00	$892.16
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $470.40 / $584.50 / $885.59	Professional	AA	$470.40	$584.50	$885.59
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $87.21 / $305.33 / $427.50	Professional	QK	$87.21	$305.33	$427.50
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $184.00 / $289.04 / $427.46	Professional	QX	$184.00	$289.04	$427.46
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $73.66 / $276.83 / $556.44	Professional	QY	$73.66	$276.83	$556.44
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $329.75 / $533.66 / $669.21	Professional	QZ	$329.75	$533.66	$669.21
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $135.59 / $240.72 / $640.00	Professional	AA	$135.59	$240.72	$640.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $70.20 / $98.95 / $300.00	Professional	QK	$70.20	$98.95	$300.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $70.20 / $109.53 / $300.00	Professional	QX	$70.20	$109.53	$300.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $61.44 / $91.13 / $262.50	Professional	QY	$61.44	$91.13	$262.50
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $120.36 / $160.08 / $385.00	Professional	QZ	$120.36	$160.08	$385.00
Anthem BCBS Facility/Professional Professional Modifier AA Low / Median / High Price $312.12 / $312.12 / $312.12	Professional	AA	$312.12	$312.12	$312.12
CareSource Facility/Professional Facility Modifier Low / Median / High Price $60.56 / $156.47 / $408.00	Facility		$60.56	$156.47	$408.00
Cigna Facility/Professional Professional Modifier QK Low / Median / High Price $174.00 / $174.00 / $180.00	Professional	QK	$174.00	$174.00	$180.00
Cigna Facility/Professional Professional Modifier QX Low / Median / High Price $174.00 / $174.00 / $180.00	Professional	QX	$174.00	$174.00	$180.00
Cigna Facility/Professional Professional Modifier QY Low / Median / High Price $174.00 / $174.00 / $180.00	Professional	QY	$174.00	$174.00	$180.00
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $15.79 / $184.53 / $619.48	Facility		$15.79	$184.53	$619.48
Medical Mutual of Ohio Facility/Professional Professional Modifier QK Low / Median / High Price $22.42 / $70.08 / $330.40	Professional	QK	$22.42	$70.08	$330.40
Medical Mutual of Ohio Facility/Professional Professional Modifier QX Low / Median / High Price $53.10 / $109.20 / $327.60	Professional	QX	$53.10	$109.20	$327.60
Medical Mutual of Ohio Facility/Professional Professional Modifier QY Low / Median / High Price $54.00 / $89.25 / $329.40	Professional	QY	$54.00	$89.25	$329.40
United Facility/Professional Professional Modifier AA Low / Median / High Price $365.00 / $365.00 / $365.00	Professional	AA	$365.00	$365.00	$365.00
United Facility/Professional Professional Modifier QX Low / Median / High Price $85.00 / $85.00 / $211.50	Professional	QX	$85.00	$85.00	$211.50
United Facility/Professional Professional Modifier QY Low / Median / High Price $90.00 / $90.00 / $189.00	Professional	QY	$90.00	$90.00	$189.00