Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $302.00 / $309.03 / $416.87	Facility		$302.00	$309.03	$416.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $47.86 / $602.56	Professional		$30.20	$47.86	$602.56
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $389.05 / $2,041.74 / $2,818.38	Professional	AA	$389.05	$2,041.74	$2,818.38
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $295.12 / $426.58 / $549.54	Professional	QX	$295.12	$426.58	$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
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $120.23 / $134.90 / $346.74	Professional	QZ	$120.23	$134.90	$346.74
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $117.49 / $141.25 / $309.03	Professional	QZ	$117.49	$141.25	$309.03
BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $85.11 / $190.55 / $257.04	Professional	QX	$85.11	$190.55	$257.04
BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $162.18 / $363.08 / $478.63	Professional	QZ	$162.18	$363.08	$478.63
CareSource Facility/Professional Facility Modifier Low / Median / High Price $363.08 / $363.08 / $588.84	Facility		$363.08	$363.08	$588.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $389.05 / $1,202.26	Professional		$199.53	$389.05	$1,202.26
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $309.03 / $309.03 / $407.38	Facility		$309.03	$309.03	$407.38
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $346.74 / $602.56	Professional		$40.74	$346.74	$602.56
Health Alliance Plan Facility/Professional Professional Modifier AA Low / Median / High Price $537.03 / $2,238.72 / $2,818.38	Professional	AA	$537.03	$2,238.72	$2,818.38
Health Alliance Plan Facility/Professional Professional Modifier QX Low / Median / High Price $309.03 / $371.54 / $478.63	Professional	QX	$309.03	$371.54	$478.63
Health Alliance Plan Facility/Professional Professional Modifier QZ Low / Median / High Price $120.23 / $134.90 / $346.74	Professional	QZ	$120.23	$134.90	$346.74
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $354.81 / $1,202.26	Professional		$194.98	$354.81	$1,202.26
United Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $53.70 / $79.43	Professional		$41.69	$53.70	$79.43