Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $230.82 / $631.79 / $1,078.43	Facility		$230.82	$631.79	$1,078.43
Aetna Facility/Professional Facility Modifier AA Low / Median / High Price $637.17 / $637.17 / $637.17	Facility	AA	$637.17	$637.17	$637.17
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $333.00 / $892.16 / $892.16	Facility	QZ	$333.00	$892.16	$892.16
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $329.75 / $490.00 / $792.37	Professional	AA	$329.75	$490.00	$792.37
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $98.99 / $292.25 / $355.50	Professional	QK	$98.99	$292.25	$355.50
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $147.50 / $282.37 / $348.81	Professional	QX	$147.50	$282.37	$348.81
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $73.66 / $247.50 / $334.60	Professional	QY	$73.66	$247.50	$334.60
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $352.89 / $516.73 / $631.17	Professional	QZ	$352.89	$516.73	$631.17
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $156.47 / $325.00 / $675.00	Professional	AA	$156.47	$325.00	$675.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $61.44 / $91.27 / $262.50	Professional	QK	$61.44	$91.27	$262.50
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $60.18 / $84.25 / $375.00	Professional	QX	$60.18	$84.25	$375.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $59.37 / $104.31 / $292.50	Professional	QY	$59.37	$104.31	$292.50
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $120.36 / $154.46 / $219.06	Professional	QZ	$120.36	$154.46	$219.06
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 $49.35 / $130.38 / $340.00	Facility		$49.35	$130.38	$340.00
Cigna Facility/Professional Professional Modifier QK Low / Median / High Price $145.00 / $150.00 / $150.00	Professional	QK	$145.00	$150.00	$150.00
Cigna Facility/Professional Professional Modifier QX Low / Median / High Price $145.00 / $150.00 / $150.00	Professional	QX	$145.00	$150.00	$150.00
Cigna Facility/Professional Professional Modifier QY Low / Median / High Price $145.00 / $150.00 / $150.00	Professional	QY	$145.00	$150.00	$150.00
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $12.77 / $157.22 / $646.16	Facility		$12.77	$157.22	$646.16
Medical Mutual of Ohio Facility/Professional Professional Modifier QK Low / Median / High Price $40.00 / $74.70 / $192.15	Professional	QK	$40.00	$74.70	$192.15
Medical Mutual of Ohio Facility/Professional Professional Modifier QX Low / Median / High Price $81.67 / $133.65 / $300.00	Professional	QX	$81.67	$133.65	$300.00
Medical Mutual of Ohio Facility/Professional Professional Modifier QY Low / Median / High Price $175.00 / $175.00 / $175.00	Professional	QY	$175.00	$175.00	$175.00
United Facility/Professional Professional Modifier QK Low / Median / High Price $130.00 / $130.00 / $130.00	Professional	QK	$130.00	$130.00	$130.00