Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $400.00 / $420.00 / $553.76	Facility		$400.00	$420.00	$553.76
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $805.80 / $984.00 / $1,799.20	Professional	AA	$805.80	$984.00	$1,799.20
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $471.90 / $683.06 / $858.99	Professional	QK	$471.90	$683.06	$858.99
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $400.95 / $609.84 / $827.64	Professional	QX	$400.95	$609.84	$827.64
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $202.50 / $233.97 / $459.43	Professional	AA	$202.50	$233.97	$459.43
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $101.25 / $150.44 / $190.57	Professional	QK	$101.25	$150.44	$190.57
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $119.64 / $132.94 / $164.53	Professional	QX	$119.64	$132.94	$164.53
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $222.75 / $334.13 / $334.13	Professional	QZ	$222.75	$334.13	$334.13
BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $137.06 / $267.75 / $355.95	Professional	QX	$137.06	$267.75	$355.95
BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $258.86 / $505.75 / $672.35	Professional	QZ	$258.86	$505.75	$672.35
CareSource Facility/Professional Facility Modifier Low / Median / High Price $482.16 / $791.84 / $791.84	Facility		$482.16	$791.84	$791.84
Cigna Facility/Professional Professional Modifier QK Low / Median / High Price $240.00 / $240.00 / $623.26	Professional	QK	$240.00	$240.00	$623.26
Cigna Facility/Professional Professional Modifier QX Low / Median / High Price $240.00 / $240.00 / $623.26	Professional	QX	$240.00	$240.00	$623.26
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $176.81 / $416.00 / $553.76	Facility		$176.81	$416.00	$553.76
Health Alliance Plan Facility/Professional Professional Modifier AA Low / Median / High Price $805.80 / $984.00 / $1,627.56	Professional	AA	$805.80	$984.00	$1,627.56
Health Alliance Plan Facility/Professional Professional Modifier QK Low / Median / High Price $471.90 / $683.06 / $858.99	Professional	QK	$471.90	$683.06	$858.99
Health Alliance Plan Facility/Professional Professional Modifier QX Low / Median / High Price $400.95 / $609.84 / $827.64	Professional	QX	$400.95	$609.84	$827.64