Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $48.00 / $434.60 / $633.86	Facility		$48.00	$434.60	$633.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.00 / $48.00 / $503.52	Professional		$38.00	$48.00	$503.52
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $387.60 / $387.60 / $387.60	Professional	AA	$387.60	$387.60	$387.60
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $215.14 / $215.14 / $215.14	Professional	QY	$215.14	$215.14	$215.14
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $227.50 / $227.50 / $227.50	Professional	QX	$227.50	$227.50	$227.50
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $36.51 / $140.41 / $455.00	Professional	QZ	$36.51	$140.41	$455.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $105.92 / $381.00 / $485.46	Professional		$105.92	$381.00	$485.46
CareSource Facility/Professional Facility Modifier Low / Median / High Price $60.56 / $156.47 / $450.00	Facility		$60.56	$156.47	$450.00
CareSource Facility/Professional Professional Modifier Low / Median / High Price $69.06 / $165.75 / $346.80	Professional		$69.06	$165.75	$346.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $215.00 / $318.25 / $441.10	Professional		$215.00	$318.25	$441.10
Cigna Facility/Professional Professional Modifier QX Low / Median / High Price $174.00 / $180.00 / $180.00	Professional	QX	$174.00	$180.00	$180.00
Cigna Facility/Professional Professional Modifier QY Low / Median / High Price $174.00 / $180.00 / $180.00	Professional	QY	$174.00	$180.00	$180.00
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $109.43 / $247.26 / $427.03	Facility		$109.43	$247.26	$427.03
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $175.00 / $300.00 / $420.00	Professional		$175.00	$300.00	$420.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $46.61 / $52.56 / $87.61	Professional		$46.61	$52.56	$87.61
United Facility/Professional Professional Modifier Low / Median / High Price $40.00 / $58.00 / $81.00	Professional		$40.00	$58.00	$81.00