Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier QK Low / Median / High Price $412.68 / $412.68 / $412.68	Facility	QK	$412.68	$412.68	$412.68
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $961.94 / $961.94 / $961.94	Facility	QZ	$961.94	$961.94	$961.94
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $426.80 / $656.10 / $941.52	Professional	AA	$426.80	$656.10	$941.52
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $86.74 / $334.60 / $451.88	Professional	QK	$86.74	$334.60	$451.88
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $253.31 / $336.35 / $451.88	Professional	QX	$253.31	$336.35	$451.88
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $98.57 / $330.37 / $419.31	Professional	QY	$98.57	$330.37	$419.31
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $399.17 / $608.10 / $838.63	Professional	QZ	$399.17	$608.10	$838.63
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $160.47 / $200.40 / $576.00	Professional	AA	$160.47	$200.40	$576.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $80.23 / $124.68 / $292.50	Professional	QK	$80.23	$124.68	$292.50
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $90.27 / $117.18 / $300.00	Professional	QX	$90.27	$117.18	$300.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $70.31 / $91.27 / $297.00	Professional	QY	$70.31	$91.27	$297.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $140.41 / $180.54 / $250.35	Professional	QZ	$140.41	$180.54	$250.35
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
Cigna Facility/Professional Professional Modifier QK Low / Median / High Price $174.00 / $180.00 / $180.00	Professional	QK	$174.00	$180.00	$180.00
Cigna Facility/Professional Professional Modifier QX Low / Median / High Price $174.00 / $180.00 / $180.00	Professional	QX	$174.00	$180.00	$180.00
Cigna Facility/Professional Professional Modifier QY Low / Median / High Price $174.00 / $180.00 / $180.00	Professional	QY	$174.00	$180.00	$180.00
Medical Mutual of Ohio Facility/Professional Professional Modifier QK Low / Median / High Price $8.86 / $50.16 / $243.00	Professional	QK	$8.86	$50.16	$243.00
Medical Mutual of Ohio Facility/Professional Professional Modifier QX Low / Median / High Price $8.97 / $23.23 / $270.00	Professional	QX	$8.97	$23.23	$270.00