Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $47.86 / $47.86 / $457.09	Facility		$47.86	$47.86	$457.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $47.86 / $537.03	Professional		$32.36	$47.86	$537.03
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $389.05 / $389.05 / $1,479.11	Professional	AA	$389.05	$389.05	$1,479.11
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $295.12 / $489.78 / $549.54	Professional	QX	$295.12	$489.78	$549.54
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $295.12 / $309.03 / $489.78	Professional	QY	$295.12	$309.03	$489.78
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $77.62 / $77.62 / $151.36	Professional	QX	$77.62	$77.62	$151.36
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $117.49 / $117.49 / $354.81	Professional	QZ	$117.49	$117.49	$354.81
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $104.71 / $309.03	Professional		$72.44	$104.71	$309.03
CareSource Facility/Professional Facility Modifier Low / Median / High Price $67.61 / $173.78 / $467.74	Facility		$67.61	$173.78	$467.74
CareSource Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $117.49 / $251.19	Professional		$66.07	$117.49	$251.19
Cigna Facility/Professional Facility Modifier Low / Median / High Price $61.66 / $61.66 / $61.66	Facility		$61.66	$61.66	$61.66
Cigna Facility/Professional Facility Modifier QK Low / Median / High Price $30.90 / $30.90 / $30.90	Facility	QK	$30.90	$30.90	$30.90
Cigna Facility/Professional Facility Modifier QX Low / Median / High Price $30.90 / $30.90 / $30.90	Facility	QX	$30.90	$30.90	$30.90
Cigna Facility/Professional Facility Modifier QY Low / Median / High Price $30.90 / $30.90 / $30.90	Facility	QY	$30.90	$30.90	$30.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $323.59 / $794.33	Professional		$199.53	$323.59	$794.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $269.15 / $302.00	Professional		$269.15	$269.15	$302.00
United Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $54.95 / $70.79	Professional		$41.69	$54.95	$70.79