Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $52.00 / $262.50 / $360.00	Facility		$52.00	$262.50	$360.00
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $496.71 / $496.71 / $923.40	Facility	QZ	$496.71	$496.71	$923.40
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $248.53 / $498.00 / $840.00	Professional	AA	$248.53	$498.00	$840.00
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $183.93 / $283.14 / $462.00	Professional	QK	$183.93	$283.14	$462.00
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $165.54 / $261.17 / $435.60	Professional	QX	$165.54	$261.17	$435.60
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $187.00 / $265.32 / $452.10	Professional	QY	$187.00	$265.32	$452.10
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $349.47 / $392.38 / $836.00	Professional	QZ	$349.47	$392.38	$836.00
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $109.25 / $127.62 / $243.00	Professional	AA	$109.25	$127.62	$243.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $60.75 / $74.45 / $330.00	Professional	QK	$60.75	$74.45	$330.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $63.81 / $74.45 / $106.35	Professional	QX	$63.81	$74.45	$106.35
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $96.39 / $96.39 / $106.35	Professional	QY	$96.39	$96.39	$106.35
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $121.50 / $127.01 / $182.25	Professional	QZ	$121.50	$127.01	$182.25
BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $78.31 / $179.15 / $203.40	Professional	QX	$78.31	$179.15	$203.40
BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $147.91 / $338.39 / $384.20	Professional	QZ	$147.91	$338.39	$384.20
CareSource Facility/Professional Facility Modifier Low / Median / High Price $301.35 / $494.90 / $494.90	Facility		$301.35	$494.90	$494.90
Cigna Facility/Professional Professional Modifier QK Low / Median / High Price $150.00 / $150.00 / $538.27	Professional	QK	$150.00	$150.00	$538.27
Cigna Facility/Professional Professional Modifier QX Low / Median / High Price $150.00 / $150.00 / $538.27	Professional	QX	$150.00	$150.00	$538.27
Cigna Facility/Professional Professional Modifier QY Low / Median / High Price $150.00 / $150.00 / $538.27	Professional	QY	$150.00	$150.00	$538.27
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $250.00 / $260.00 / $360.00	Facility		$250.00	$260.00	$360.00
Health Alliance Plan Facility/Professional Facility Modifier QZ Low / Median / High Price $496.71 / $496.71 / $496.71	Facility	QZ	$496.71	$496.71	$496.71
Health Alliance Plan Facility/Professional Professional Modifier AA Low / Median / High Price $299.04 / $577.15 / $883.96	Professional	AA	$299.04	$577.15	$883.96
Health Alliance Plan Facility/Professional Professional Modifier QK Low / Median / High Price $198.25 / $323.39 / $462.00	Professional	QK	$198.25	$323.39	$462.00
Health Alliance Plan Facility/Professional Professional Modifier QX Low / Median / High Price $165.54 / $290.70 / $455.40	Professional	QX	$165.54	$290.70	$455.40
Health Alliance Plan Facility/Professional Professional Modifier QY Low / Median / High Price $211.52 / $275.23 / $452.10	Professional	QY	$211.52	$275.23	$452.10
Health Alliance Plan Facility/Professional Professional Modifier QZ Low / Median / High Price $349.47 / $484.35 / $792.00	Professional	QZ	$349.47	$484.35	$792.00