Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $251.19 / $257.04 / $363.08	Facility		$251.19	$257.04	$363.08
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $501.19 / $933.25 / $933.25	Facility	QZ	$501.19	$933.25	$933.25
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $407.38 / $794.33 / $1,202.26	Professional	AA	$407.38	$794.33	$1,202.26
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $181.97 / $346.74 / $645.65	Professional	QK	$181.97	$346.74	$645.65
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $177.83 / $338.84 / $630.96	Professional	QX	$177.83	$338.84	$630.96
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $229.09 / $323.59 / $691.83	Professional	QY	$229.09	$323.59	$691.83
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $295.12 / $549.54 / $1,071.52	Professional	QZ	$295.12	$549.54	$1,071.52
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $117.49 / $162.18 / $275.42	Professional	AA	$117.49	$162.18	$275.42
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $60.26 / $70.79 / $128.82	Professional	QK	$60.26	$70.79	$128.82
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $51.29 / $70.79 / $114.82	Professional	QX	$51.29	$70.79	$114.82
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $61.66 / $67.61 / $181.97	Professional	QY	$61.66	$67.61	$181.97
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $117.49 / $141.25 / $257.04	Professional	QZ	$117.49	$141.25	$257.04
BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $151.36 / $177.83 / $177.83	Professional	QX	$151.36	$177.83	$177.83
BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $288.40 / $338.84 / $338.84	Professional	QZ	$288.40	$338.84	$338.84
CareSource Facility/Professional Facility Modifier Low / Median / High Price $302.00 / $302.00 / $489.78	Facility		$302.00	$302.00	$489.78
Health Alliance Plan Facility/Professional Facility Modifier Low / Median / High Price $251.19 / $257.04 / $363.08	Facility		$251.19	$257.04	$363.08
Health Alliance Plan Facility/Professional Facility Modifier QZ Low / Median / High Price $501.19 / $501.19 / $501.19	Facility	QZ	$501.19	$501.19	$501.19
Health Alliance Plan Facility/Professional Professional Modifier AA Low / Median / High Price $467.74 / $776.25 / $1,174.90	Professional	AA	$467.74	$776.25	$1,174.90
Health Alliance Plan Facility/Professional Professional Modifier QK Low / Median / High Price $199.53 / $363.08 / $616.60	Professional	QK	$199.53	$363.08	$616.60
Health Alliance Plan Facility/Professional Professional Modifier QX Low / Median / High Price $177.83 / $354.81 / $616.60	Professional	QX	$177.83	$354.81	$616.60
Health Alliance Plan Facility/Professional Professional Modifier QY Low / Median / High Price $194.98 / $354.81 / $691.83	Professional	QY	$194.98	$354.81	$691.83
Health Alliance Plan Facility/Professional Professional Modifier QZ Low / Median / High Price $316.23 / $512.86 / $812.83	Professional	QZ	$316.23	$512.86	$812.83