Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $45.00 / $400.00 / $450.00	Facility		$45.00	$400.00	$450.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $287.69 / $382.20 / $639.00	Professional	AA	$287.69	$382.20	$639.00
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $274.50 / $274.50 / $274.50	Professional	QX	$274.50	$274.50	$274.50
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $560.07 / $560.07 / $567.00	Professional	QZ	$560.07	$560.07	$567.00
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $96.85 / $194.49 / $402.00	Professional	AA	$96.85	$194.49	$402.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $12.88 / $129.66 / $145.87	Professional	QX	$12.88	$129.66	$145.87
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $103.05 / $145.87 / $145.87	Professional	QY	$103.05	$145.87	$145.87
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $96.85 / $116.22 / $189.83	Professional	QZ	$96.85	$116.22	$189.83
CareSource Facility/Professional Facility Modifier Low / Median / High Price $51.62 / $130.75 / $201.45	Facility		$51.62	$130.75	$201.45
Cigna Facility/Professional Professional Modifier QX Low / Median / High Price $150.00 / $150.00 / $150.00	Professional	QX	$150.00	$150.00	$150.00
Cigna Facility/Professional Professional Modifier QY Low / Median / High Price $150.00 / $150.00 / $150.00	Professional	QY	$150.00	$150.00	$150.00