Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $81.28 / $416.87 / $741.31	Facility		$81.28	$416.87	$741.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $50.12 / $630.96	Professional		$30.20	$50.12	$630.96
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 $263.03 / $346.74 / $549.54	Professional	QX	$263.03	$346.74	$549.54
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $218.78 / $295.12 / $489.78	Professional	QY	$218.78	$295.12	$489.78
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $120.23 / $138.04 / $436.52	Professional	QZ	$120.23	$138.04	$436.52
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $97.72 / $97.72 / $97.72	Professional	QX	$97.72	$97.72	$97.72
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $97.72 / $97.72 / $97.72	Professional	QY	$97.72	$97.72	$97.72
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $117.49 / $141.25 / $144.54	Professional	QZ	$117.49	$141.25	$144.54
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $380.19 / $467.74	Professional		$104.71	$380.19	$467.74
Aultcare Facility/Professional Professional Modifier AA Low / Median / High Price $380.19 / $380.19 / $457.09	Professional	AA	$380.19	$380.19	$457.09
Aultcare Facility/Professional Professional Modifier QZ Low / Median / High Price $275.42 / $346.74 / $562.34	Professional	QZ	$275.42	$346.74	$562.34
CareSource Facility/Professional Facility Modifier Low / Median / High Price $47.86 / $77.62 / $213.80	Facility		$47.86	$77.62	$213.80
CareSource Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $79.43 / $239.88	Professional		$67.61	$79.43	$239.88
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 Professional Modifier Low / Median / High Price $208.93 / $316.23 / $457.09	Professional		$208.93	$316.23	$457.09
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $95.50 / $257.04 / $416.87	Facility		$95.50	$257.04	$416.87
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $288.40 / $407.38	Professional		$38.90	$288.40	$407.38
Molina Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $52.48 / $87.10	Professional		$46.77	$52.48	$87.10
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $257.04 / $537.03	Professional		$109.65	$257.04	$537.03
SummaCare Facility/Professional Professional Modifier QX Low / Median / High Price $162.18 / $162.18 / $162.18	Professional	QX	$162.18	$162.18	$162.18
SummaCare Facility/Professional Professional Modifier QY Low / Median / High Price $162.18 / $162.18 / $162.18	Professional	QY	$162.18	$162.18	$162.18
United Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $54.95 / $75.86	Professional		$39.81	$54.95	$75.86