Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $223.87 / $645.65 / $1,122.02	Facility		$223.87	$645.65	$1,122.02
Aetna Facility/Professional Facility Modifier AA Low / Median / High Price $630.96 / $630.96 / $630.96	Facility	AA	$630.96	$630.96	$630.96
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $331.13 / $891.25 / $891.25	Facility	QZ	$331.13	$891.25	$891.25
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $380.19 / $741.31 / $1,202.26	Professional	AA	$380.19	$741.31	$1,202.26
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $208.93 / $302.00 / $512.86	Professional	QK	$208.93	$302.00	$512.86
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $213.80 / $309.03 / $512.86	Professional	QX	$213.80	$309.03	$512.86
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $223.87 / $281.84 / $416.87	Professional	QY	$223.87	$281.84	$416.87
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $295.12 / $537.03 / $707.95	Professional	QZ	$295.12	$537.03	$707.95
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $117.49 / $162.18 / $512.86	Professional	AA	$117.49	$162.18	$512.86
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $60.26 / $74.13 / $97.72	Professional	QK	$60.26	$74.13	$97.72
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $61.66 / $72.44 / $97.72	Professional	QX	$61.66	$72.44	$97.72
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $61.66 / $63.10 / $131.83	Professional	QY	$61.66	$63.10	$131.83
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $117.49 / $144.54 / $204.17	Professional	QZ	$117.49	$144.54	$204.17
Anthem BCBS Facility/Professional Professional Modifier AA Low / Median / High Price $309.03 / $309.03 / $309.03	Professional	AA	$309.03	$309.03	$309.03
Aultcare Facility/Professional Professional Modifier AA Low / Median / High Price $346.74 / $389.05 / $562.34	Professional	AA	$346.74	$389.05	$562.34
Aultcare Facility/Professional Professional Modifier QK Low / Median / High Price $97.72 / $173.78 / $194.98	Professional	QK	$97.72	$173.78	$194.98
Aultcare Facility/Professional Professional Modifier QX Low / Median / High Price $128.82 / $169.82 / $218.78	Professional	QX	$128.82	$169.82	$218.78
Aultcare Facility/Professional Professional Modifier QY Low / Median / High Price $208.93 / $213.80 / $263.03	Professional	QY	$208.93	$213.80	$263.03
Aultcare Facility/Professional Professional Modifier QZ Low / Median / High Price $275.42 / $309.03 / $416.87	Professional	QZ	$275.42	$309.03	$416.87
CareSource Facility/Professional Facility Modifier Low / Median / High Price $39.81 / $64.57 / $177.83	Facility		$39.81	$64.57	$177.83
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $13.80 / $181.97 / $645.65	Facility		$13.80	$181.97	$645.65
Medical Mutual of Ohio Facility/Professional Professional Modifier QK Low / Median / High Price $39.81 / $74.13 / $190.55	Professional	QK	$39.81	$74.13	$190.55
Medical Mutual of Ohio Facility/Professional Professional Modifier QX Low / Median / High Price $53.70 / $134.90 / $302.00	Professional	QX	$53.70	$134.90	$302.00
Medical Mutual of Ohio Facility/Professional Professional Modifier QY Low / Median / High Price $173.78 / $173.78 / $173.78	Professional	QY	$173.78	$173.78	$173.78
SummaCare Facility/Professional Professional Modifier QK Low / Median / High Price $100.00 / $128.82 / $151.36	Professional	QK	$100.00	$128.82	$151.36
SummaCare Facility/Professional Professional Modifier QX Low / Median / High Price $89.13 / $128.82 / $151.36	Professional	QX	$89.13	$128.82	$151.36
SummaCare Facility/Professional Professional Modifier QY Low / Median / High Price $89.13 / $128.82 / $169.82	Professional	QY	$89.13	$128.82	$169.82