Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $45.00 / $400.00 / $450.00	Facility		$45.00	$400.00	$450.00
Aetna Facility/Professional Facility Modifier QX Low / Median / High Price $151.97 / $151.97 / $151.97	Facility	QX	$151.97	$151.97	$151.97
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $326.04 / $549.00 / $792.00	Professional	AA	$326.04	$549.00	$792.00
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $195.14 / $328.33 / $337.50	Professional	QK	$195.14	$328.33	$337.50
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $225.00 / $274.50 / $346.50	Professional	QX	$225.00	$274.50	$346.50
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $230.26 / $274.50 / $342.35	Professional	QY	$230.26	$274.50	$342.35
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $274.50 / $345.22 / $495.00	Professional	QZ	$274.50	$345.22	$495.00
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $151.09 / $221.65 / $525.00	Professional	AA	$151.09	$221.65	$525.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $60.75 / $95.88 / $135.00	Professional	QK	$60.75	$95.88	$135.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $10.65 / $97.25 / $113.45	Professional	QX	$10.65	$97.25	$113.45
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $59.37 / $96.39 / $157.50	Professional	QY	$59.37	$96.39	$157.50
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $116.22 / $189.83 / $385.00	Professional	QZ	$116.22	$189.83	$385.00
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $220.00 / $220.00 / $424.60	Facility		$220.00	$220.00	$424.60
CareSource Facility/Professional Facility Modifier Low / Median / High Price $51.62 / $130.75 / $201.45	Facility		$51.62	$130.75	$201.45
Cigna Facility/Professional Professional Modifier QK Low / Median / High Price $150.00 / $150.00 / $150.00	Professional	QK	$150.00	$150.00	$150.00
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