Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $398.11 / $416.87 / $562.34	Facility		$398.11	$416.87	$562.34
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $812.83 / $1,380.38 / $2,754.23	Professional	AA	$812.83	$1,380.38	$2,754.23
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $346.74 / $562.34 / $851.14	Professional	QK	$346.74	$562.34	$851.14
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $380.19 / $562.34 / $851.14	Professional	QX	$380.19	$562.34	$851.14
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $1,412.54 / $2,187.76 / $3,090.30	Professional	QZ	$1,412.54	$2,187.76	$3,090.30
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $213.80 / $281.84 / $575.44	Professional	AA	$213.80	$281.84	$575.44
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $91.20 / $107.15 / $199.53	Professional	QK	$91.20	$107.15	$199.53
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $91.20 / $107.15 / $199.53	Professional	QX	$91.20	$107.15	$199.53
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $181.97 / $199.53 / $302.00	Professional	QZ	$181.97	$199.53	$302.00
BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $120.23 / $269.15 / $354.81	Professional	QX	$120.23	$269.15	$354.81
BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $223.87 / $501.19 / $676.08	Professional	QZ	$223.87	$501.19	$676.08
CareSource Facility/Professional Facility Modifier Low / Median / High Price $478.63 / $478.63 / $794.33	Facility		$478.63	$478.63	$794.33
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $398.11 / $416.87 / $537.03	Facility		$398.11	$416.87	$537.03
Health Alliance Plan Facility/Professional Professional Modifier AA Low / Median / High Price $870.96 / $1,412.54 / $2,884.03	Professional	AA	$870.96	$1,412.54	$2,884.03
Health Alliance Plan Facility/Professional Professional Modifier QK Low / Median / High Price $416.87 / $645.65 / $891.25	Professional	QK	$416.87	$645.65	$891.25
Health Alliance Plan Facility/Professional Professional Modifier QX Low / Median / High Price $389.05 / $616.60 / $870.96	Professional	QX	$389.05	$616.60	$870.96
Health Alliance Plan Facility/Professional Professional Modifier QZ Low / Median / High Price $1,412.54 / $1,412.54 / $1,412.54	Professional	QZ	$1,412.54	$1,412.54	$1,412.54