Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $250.00 / $262.50 / $360.00	Facility		$250.00	$262.50	$360.00
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $496.71 / $496.71 / $496.71	Facility	QZ	$496.71	$496.71	$496.71
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $373.99 / $497.70 / $728.34	Professional	AA	$373.99	$497.70	$728.34
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $180.86 / $323.39 / $452.20	Professional	QK	$180.86	$323.39	$452.20
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $165.54 / $271.22 / $429.00	Professional	QX	$165.54	$271.22	$429.00
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $156.34 / $281.26 / $369.60	Professional	QY	$156.34	$281.26	$369.60
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $306.55 / $361.73 / $480.98	Professional	QZ	$306.55	$361.73	$480.98
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $100.30 / $127.62 / $172.29	Professional	AA	$100.30	$127.62	$172.29
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $50.63 / $86.14 / $198.00	Professional	QK	$50.63	$86.14	$198.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $53.18 / $60.75 / $95.72	Professional	QX	$53.18	$60.75	$95.72
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $53.18 / $59.67 / $74.45	Professional	QY	$53.18	$59.67	$74.45
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $101.25 / $127.62 / $202.50	Professional	QZ	$101.25	$127.62	$202.50
BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $58.74 / $143.32 / $152.55	Professional	QX	$58.74	$143.32	$152.55
BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $110.94 / $270.70 / $288.14	Professional	QZ	$110.94	$270.70	$288.14
CareSource Facility/Professional Facility Modifier Low / Median / High Price $241.08 / $395.92 / $395.92	Facility		$241.08	$395.92	$395.92
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 $260.00 / $260.00 / $723.90	Facility		$260.00	$260.00	$723.90
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 $373.99 / $505.60 / $813.78	Professional	AA	$373.99	$505.60	$813.78
Health Alliance Plan Facility/Professional Professional Modifier QK Low / Median / High Price $196.19 / $348.48 / $462.00	Professional	QK	$196.19	$348.48	$462.00
Health Alliance Plan Facility/Professional Professional Modifier QX Low / Median / High Price $154.88 / $298.48 / $435.60	Professional	QX	$154.88	$298.48	$435.60
Health Alliance Plan Facility/Professional Professional Modifier QY Low / Median / High Price $182.00 / $309.54 / $453.84	Professional	QY	$182.00	$309.54	$453.84
Health Alliance Plan Facility/Professional Professional Modifier QZ Low / Median / High Price $306.55 / $371.28 / $561.15	Professional	QZ	$306.55	$371.28	$561.15