Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $48.00 / $48.00 / $885.58	Facility		$48.00	$48.00	$885.58
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $370.79 / $470.40 / $980.00	Professional	AA	$370.79	$470.40	$980.00
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $96.48 / $195.30 / $246.40	Professional	QK	$96.48	$195.30	$246.40
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $138.32 / $138.32 / $251.10	Professional	QX	$138.32	$138.32	$251.10
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $250.51 / $495.00 / $1,014.90	Professional	QZ	$250.51	$495.00	$1,014.90
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $110.82 / $158.32 / $1,012.00	Professional	AA	$110.82	$158.32	$1,012.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $69.27 / $98.95 / $368.00	Professional	QK	$69.27	$98.95	$368.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $70.20 / $98.95 / $322.00	Professional	QX	$70.20	$98.95	$322.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $109.74 / $276.00 / $598.00	Professional	QY	$109.74	$276.00	$598.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $126.66 / $187.02 / $736.00	Professional	QZ	$126.66	$187.02	$736.00
CareSource Facility/Professional Facility Modifier Low / Median / High Price $71.16 / $189.83 / $473.10	Facility		$71.16	$189.83	$473.10
Cigna Facility/Professional Professional Modifier QK Low / Median / High Price $180.00 / $180.00 / $180.00	Professional	QK	$180.00	$180.00	$180.00
Cigna Facility/Professional Professional Modifier QX Low / Median / High Price $180.00 / $180.00 / $180.00	Professional	QX	$180.00	$180.00	$180.00
Cigna Facility/Professional Professional Modifier QY Low / Median / High Price $180.00 / $180.00 / $180.00	Professional	QY	$180.00	$180.00	$180.00