Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $300.00 / $315.00 / $415.32	Facility		$300.00	$315.00	$415.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.00 / $45.10 / $315.00	Professional		$35.00	$45.10	$315.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $543.15 / $543.15 / $543.15	Professional	AA	$543.15	$543.15	$543.15
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $36.51 / $36.51 / $36.51	Professional	QZ	$36.51	$36.51	$36.51
BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $97.90 / $191.25 / $254.25	Professional	QX	$97.90	$191.25	$254.25
BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $184.90 / $361.25 / $480.25	Professional	QZ	$184.90	$361.25	$480.25
CareSource Facility/Professional Facility Modifier Low / Median / High Price $361.62 / $593.88 / $593.88	Facility		$361.62	$593.88	$593.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $237.50 / $815.80 / $1,400.00	Professional		$237.50	$815.80	$1,400.00
Cigna Facility/Professional Professional Modifier QX Low / Median / High Price $180.00 / $180.00 / $566.60	Professional	QX	$180.00	$180.00	$566.60
Cigna Facility/Professional Professional Modifier QY Low / Median / High Price $180.00 / $180.00 / $566.60	Professional	QY	$180.00	$180.00	$566.60
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $312.00 / $312.00 / $415.32	Facility		$312.00	$312.00	$415.32
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $45.00 / $312.00 / $432.00	Professional		$45.00	$312.00	$432.00
Health Alliance Plan Facility/Professional Professional Modifier AA Low / Median / High Price $543.15 / $543.15 / $543.15	Professional	AA	$543.15	$543.15	$543.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.00 / $47.09 / $107.84	Professional		$30.00	$47.09	$107.84
United Facility/Professional Professional Modifier Low / Median / High Price $42.00 / $54.00 / $85.00	Professional		$42.00	$54.00	$85.00