Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $776.25 / $1,412.54 / $2,691.53	Professional	AA	$776.25	$1,412.54	$2,691.53
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $338.84 / $575.44 / $912.01	Professional	QX	$338.84	$575.44	$912.01
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $316.23 / $588.84 / $1,778.28	Professional	QY	$316.23	$588.84	$1,778.28
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $467.74 / $891.25 / $1,412.54	Professional	QZ	$467.74	$891.25	$1,412.54
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $162.18 / $275.42 / $302.00	Professional	AA	$162.18	$275.42	$302.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $102.33 / $128.82 / $186.21	Professional	QX	$102.33	$128.82	$186.21
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $186.21 / $186.21 / $186.21	Professional	QY	$186.21	$186.21	$186.21
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $186.21 / $288.40 / $758.58	Professional	QZ	$186.21	$288.40	$758.58
Aultcare Facility/Professional Professional Modifier AA Low / Median / High Price $323.59 / $630.96 / $812.83	Professional	AA	$323.59	$630.96	$812.83
Aultcare Facility/Professional Professional Modifier QX Low / Median / High Price $204.17 / $239.88 / $363.08	Professional	QX	$204.17	$239.88	$363.08
Aultcare Facility/Professional Professional Modifier QY Low / Median / High Price $295.12 / $295.12 / $295.12	Professional	QY	$295.12	$295.12	$295.12
Aultcare Facility/Professional Professional Modifier QZ Low / Median / High Price $446.68 / $562.34 / $1,000.00	Professional	QZ	$446.68	$562.34	$1,000.00
Medical Mutual of Ohio Facility/Professional Professional Modifier QX Low / Median / High Price $2.75 / $51.29 / $58.88	Professional	QX	$2.75	$51.29	$58.88
Medical Mutual of Ohio Facility/Professional Professional Modifier QY Low / Median / High Price $50.12 / $50.12 / $50.12	Professional	QY	$50.12	$50.12	$50.12
SummaCare Facility/Professional Professional Modifier QX Low / Median / High Price $138.04 / $162.18 / $169.82	Professional	QX	$138.04	$162.18	$169.82