Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $47.86 / $398.11 / $812.83	Facility		$47.86	$398.11	$812.83
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $407.38 / $645.65 / $1,047.13	Professional	AA	$407.38	$645.65	$1,047.13
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $89.13 / $338.84 / $537.03	Professional	QK	$89.13	$338.84	$537.03
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $93.33 / $323.59 / $562.34	Professional	QX	$93.33	$323.59	$562.34
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $257.04 / $331.13 / $457.09	Professional	QY	$257.04	$331.13	$457.09
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $151.36 / $478.63 / $676.08	Professional	QZ	$151.36	$478.63	$676.08
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $134.90 / $181.97 / $575.44	Professional	AA	$134.90	$181.97	$575.44
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $67.61 / $114.82 / $338.84	Professional	QK	$67.61	$114.82	$338.84
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $67.61 / $117.49 / $323.59	Professional	QX	$67.61	$117.49	$323.59
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $69.18 / $117.49 / $380.19	Professional	QY	$69.18	$117.49	$380.19
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $120.23 / $173.78 / $457.09	Professional	QZ	$120.23	$173.78	$457.09
CareSource Facility/Professional Facility Modifier Low / Median / High Price $67.61 / $173.78 / $467.74	Facility		$67.61	$173.78	$467.74
Cigna Facility/Professional Facility Modifier Low / Median / High Price $61.66 / $61.66 / $61.66	Facility		$61.66	$61.66	$61.66
Cigna Facility/Professional Facility Modifier QK Low / Median / High Price $30.90 / $30.90 / $30.90	Facility	QK	$30.90	$30.90	$30.90
Cigna Facility/Professional Facility Modifier QX Low / Median / High Price $30.90 / $30.90 / $30.90	Facility	QX	$30.90	$30.90	$30.90
Cigna Facility/Professional Facility Modifier QY Low / Median / High Price $30.90 / $30.90 / $30.90	Facility	QY	$30.90	$30.90	$30.90