Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $249.08 / $838.87 / $1,677.74	Facility		$249.08	$838.87	$1,677.74
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $589.90 / $895.95 / $1,547.33	Professional	AA	$589.90	$895.95	$1,547.33
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $98.57 / $419.40 / $555.20	Professional	QK	$98.57	$419.40	$555.20
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $419.31 / $492.59 / $576.03	Professional	QX	$419.31	$492.59	$576.03
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $202.50 / $280.83 / $409.60	Professional	AA	$202.50	$280.83	$409.60
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $130.38 / $225.93 / $420.00	Professional	QK	$130.38	$225.93	$420.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $110.33 / $190.57 / $455.00	Professional	QX	$110.33	$190.57	$455.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $198.59 / $200.60 / $312.94	Professional	QZ	$198.59	$200.60	$312.94
CareSource Facility/Professional Facility Modifier Low / Median / High Price $83.20 / $213.00 / $600.00	Facility		$83.20	$213.00	$600.00
Cigna Facility/Professional Professional Modifier QK Low / Median / High Price $232.00 / $240.00 / $240.00	Professional	QK	$232.00	$240.00	$240.00
Cigna Facility/Professional Professional Modifier QX Low / Median / High Price $232.00 / $240.00 / $240.00	Professional	QX	$232.00	$240.00	$240.00
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $25.64 / $112.09 / $719.34	Facility		$25.64	$112.09	$719.34
Medical Mutual of Ohio Facility/Professional Professional Modifier QK Low / Median / High Price $113.53 / $127.17 / $213.75	Professional	QK	$113.53	$127.17	$213.75
Medical Mutual of Ohio Facility/Professional Professional Modifier QX Low / Median / High Price $117.38 / $117.38 / $117.38	Professional	QX	$117.38	$117.38	$117.38