Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $42.00 / $210.00 / $310.00	Facility		$42.00	$210.00	$310.00
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $172.80 / $207.70 / $244.90	Professional	QX	$172.80	$207.70	$244.90
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $105.66 / $127.45 / $770.00	Professional	QZ	$105.66	$127.45	$770.00
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $408.00 / $408.00 / $408.00	Professional	AA	$408.00	$408.00	$408.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $86.02 / $127.50 / $178.50	Professional	QX	$86.02	$127.50	$178.50
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $189.69 / $306.00 / $550.00	Professional	QZ	$189.69	$306.00	$550.00
Qualchoice Facility/Professional Professional Modifier AA Low / Median / High Price $469.20 / $469.20 / $469.20	Professional	AA	$469.20	$469.20	$469.20
Qualchoice Facility/Professional Professional Modifier QX Low / Median / High Price $146.63 / $146.63 / $146.63	Professional	QX	$146.63	$146.63	$146.63
Qualchoice Facility/Professional Professional Modifier QZ Low / Median / High Price $351.90 / $396.75 / $707.94	Professional	QZ	$351.90	$396.75	$707.94