Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $156.30 / $473.85 / $963.53	Facility		$156.30	$473.85	$963.53
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $106.32 / $392.00 / $840.00	Professional	AA	$106.32	$392.00	$840.00
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $65.06 / $254.13 / $380.00	Professional	QX	$65.06	$254.13	$380.00
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $53.30 / $65.67 / $201.26	Professional	QY	$53.30	$65.67	$201.26
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $113.29 / $567.55 / $851.34	Professional	QZ	$113.29	$567.55	$851.34
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $116.22 / $308.92 / $414.00	Professional	AA	$116.22	$308.92	$414.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $70.20 / $80.23 / $396.00	Professional	QX	$70.20	$80.23	$396.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $60.18 / $60.18 / $292.50	Professional	QY	$60.18	$60.18	$292.50
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $98.95 / $120.36 / $160.47	Professional	QZ	$98.95	$120.36	$160.47
CareSource Facility/Professional Facility Modifier Low / Median / High Price $49.35 / $130.38 / $340.00	Facility		$49.35	$130.38	$340.00
Cigna Facility/Professional Professional Modifier QX Low / Median / High Price $145.00 / $150.00 / $150.00	Professional	QX	$145.00	$150.00	$150.00
Cigna Facility/Professional Professional Modifier QY Low / Median / High Price $145.00 / $150.00 / $150.00	Professional	QY	$145.00	$150.00	$150.00
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $31.19 / $197.92 / $408.53	Facility		$31.19	$197.92	$408.53
Medical Mutual of Ohio Facility/Professional Professional Modifier QX Low / Median / High Price $20.00 / $20.00 / $20.00	Professional	QX	$20.00	$20.00	$20.00