Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $48.00 / $50.00 / $4,110.54	Facility		$48.00	$50.00	$4,110.54
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $122.03 / $652.79 / $980.00	Professional	AA	$122.03	$652.79	$980.00
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $172.80 / $195.14 / $195.14	Professional	QK	$172.80	$195.14	$195.14
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $138.75 / $192.20 / $722.02	Professional	QX	$138.75	$192.20	$722.02
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $332.70 / $486.00 / $895.50	Professional	QZ	$332.70	$486.00	$895.50
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $116.22 / $221.65 / $644.00	Professional	AA	$116.22	$221.65	$644.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $63.79 / $96.97 / $368.00	Professional	QK	$63.79	$96.97	$368.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $10.65 / $87.76 / $368.00	Professional	QX	$10.65	$87.76	$368.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $59.37 / $276.00 / $322.00	Professional	QY	$59.37	$276.00	$322.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $118.74 / $145.19 / $455.00	Professional	QZ	$118.74	$145.19	$455.00
CareSource Facility/Professional Facility Modifier Low / Median / High Price $57.21 / $158.32 / $394.25	Facility		$57.21	$158.32	$394.25
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