Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $234.63 / $629.62 / $981.46	Facility		$234.63	$629.62	$981.46
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $333.00 / $983.52 / $1,074.88	Facility	QZ	$333.00	$983.52	$1,074.88
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $329.75 / $506.61 / $755.76	Professional	AA	$329.75	$506.61	$755.76
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $228.72 / $283.50 / $350.11	Professional	QK	$228.72	$283.50	$350.11
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $223.91 / $265.76 / $343.08	Professional	QX	$223.91	$265.76	$343.08
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $197.79 / $260.25 / $618.38	Professional	QY	$197.79	$260.25	$618.38
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $440.49 / $550.62 / $647.79	Professional	QZ	$440.49	$550.62	$647.79
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $100.30 / $162.71 / $483.00	Professional	AA	$100.30	$162.71	$483.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $59.37 / $91.27 / $227.50	Professional	QK	$59.37	$91.27	$227.50
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $50.15 / $71.61 / $227.50	Professional	QX	$50.15	$71.61	$227.50
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $50.23 / $60.18 / $195.00	Professional	QY	$50.23	$60.18	$195.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $100.30 / $120.36 / $275.00	Professional	QZ	$100.30	$120.36	$275.00
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 $39.00 / $102.91 / $272.00	Facility		$39.00	$102.91	$272.00
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 $13.06 / $179.97 / $692.52	Facility		$13.06	$179.97	$692.52
Medical Mutual of Ohio Facility/Professional Professional Modifier QK Low / Median / High Price $47.20 / $75.00 / $266.06	Professional	QK	$47.20	$75.00	$266.06
Medical Mutual of Ohio Facility/Professional Professional Modifier QX Low / Median / High Price $46.05 / $113.75 / $225.00	Professional	QX	$46.05	$113.75	$225.00
Medical Mutual of Ohio Facility/Professional Professional Modifier QY Low / Median / High Price $158.66 / $226.80 / $226.80	Professional	QY	$158.66	$226.80	$226.80