Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier QK Low / Median / High Price $416.87 / $416.87 / $416.87	Facility	QK	$416.87	$416.87	$416.87
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $954.99 / $954.99 / $954.99	Facility	QZ	$954.99	$954.99	$954.99
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $549.54 / $1,000.00 / $1,548.82	Professional	AA	$549.54	$1,000.00	$1,548.82
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $281.84 / $371.54 / $562.34	Professional	QK	$281.84	$371.54	$562.34
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $281.84 / $380.19 / $602.56	Professional	QX	$281.84	$380.19	$602.56
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $281.84 / $371.54 / $549.54	Professional	QY	$281.84	$371.54	$549.54
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $371.54 / $616.60 / $831.76	Professional	QZ	$371.54	$616.60	$831.76
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $141.25 / $199.53 / $316.23	Professional	AA	$141.25	$199.53	$316.23
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $81.28 / $97.72 / $112.20	Professional	QK	$81.28	$97.72	$112.20
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $60.26 / $89.13 / $125.89	Professional	QX	$60.26	$89.13	$125.89
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $85.11 / $89.13 / $112.20	Professional	QY	$85.11	$89.13	$112.20
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $138.04 / $162.18 / $213.80	Professional	QZ	$138.04	$162.18	$213.80
Anthem BCBS Facility/Professional Professional Modifier AA Low / Median / High Price $309.03 / $309.03 / $309.03	Professional	AA	$309.03	$309.03	$309.03
Aultcare Facility/Professional Professional Modifier AA Low / Median / High Price $363.08 / $446.68 / $812.83	Professional	AA	$363.08	$446.68	$812.83
Aultcare Facility/Professional Professional Modifier QK Low / Median / High Price $173.78 / $208.93 / $239.88	Professional	QK	$173.78	$208.93	$239.88
Aultcare Facility/Professional Professional Modifier QX Low / Median / High Price $181.97 / $208.93 / $257.04	Professional	QX	$181.97	$208.93	$257.04
Aultcare Facility/Professional Professional Modifier QY Low / Median / High Price $218.78 / $218.78 / $218.78	Professional	QY	$218.78	$218.78	$218.78
Aultcare Facility/Professional Professional Modifier QZ Low / Median / High Price $323.59 / $407.38 / $602.56	Professional	QZ	$323.59	$407.38	$602.56
Medical Mutual of Ohio Facility/Professional Professional Modifier QK Low / Median / High Price $8.91 / $50.12 / $245.47	Professional	QK	$8.91	$50.12	$245.47
Medical Mutual of Ohio Facility/Professional Professional Modifier QX Low / Median / High Price $8.91 / $51.29 / $741.31	Professional	QX	$8.91	$51.29	$741.31
SummaCare Facility/Professional Professional Modifier QK Low / Median / High Price $89.13 / $128.82 / $151.36	Professional	QK	$89.13	$128.82	$151.36
SummaCare Facility/Professional Professional Modifier QX Low / Median / High Price $89.13 / $128.82 / $151.36	Professional	QX	$89.13	$128.82	$151.36
SummaCare Facility/Professional Professional Modifier QY Low / Median / High Price $128.82 / $128.82 / $128.82	Professional	QY	$128.82	$128.82	$128.82