Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $48.00 / $48.00 / $270.00	Facility		$48.00	$48.00	$270.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $287.69 / $540.00 / $980.00	Professional	AA	$287.69	$540.00	$980.00
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $195.30 / $415.47 / $415.47	Professional	QX	$195.30	$415.47	$415.47
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $460.80 / $895.50 / $1,014.90	Professional	QZ	$460.80	$895.50	$1,014.90
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $94.99 / $222.64 / $644.00	Professional	AA	$94.99	$222.64	$644.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $12.88 / $86.58 / $368.00	Professional	QX	$12.88	$86.58	$368.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $67.76 / $103.05 / $368.00	Professional	QY	$67.76	$103.05	$368.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $98.95 / $116.22 / $420.00	Professional	QZ	$98.95	$116.22	$420.00
CareSource Facility/Professional Facility Modifier Low / Median / High Price $57.21 / $158.32 / $394.25	Facility		$57.21	$158.32	$394.25
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