Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $45.00 / $640.00 / $720.00	Facility		$45.00	$640.00	$720.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $518.24 / $710.18 / $1,233.00	Professional	AA	$518.24	$710.18	$1,233.00
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $261.00 / $522.00 / $664.70	Professional	QK	$261.00	$522.00	$664.70
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $454.54 / $513.19 / $639.00	Professional	QX	$454.54	$513.19	$639.00
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $511.44 / $671.27 / $761.36	Professional	QZ	$511.44	$671.27	$761.36
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $233.97 / $416.46 / $880.00	Professional	AA	$233.97	$416.46	$880.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $77.48 / $159.53 / $414.00	Professional	QK	$77.48	$159.53	$414.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $166.24 / $210.70 / $291.74	Professional	QX	$166.24	$210.70	$291.74
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $200.60 / $715.00 / $1,050.00	Professional	QZ	$200.60	$715.00	$1,050.00
CareSource Facility/Professional Facility Modifier Low / Median / High Price $89.10 / $201.45 / $287.64	Facility		$89.10	$201.45	$287.64
Cigna Facility/Professional Professional Modifier QK Low / Median / High Price $240.00 / $240.00 / $240.00	Professional	QK	$240.00	$240.00	$240.00
Cigna Facility/Professional Professional Modifier QX Low / Median / High Price $240.00 / $240.00 / $240.00	Professional	QX	$240.00	$240.00	$240.00