Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $33.11 / $363.08 / $363.08	Facility		$33.11	$363.08	$363.08
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $144.54 / $616.60 / $1,122.02	Professional	AA	$144.54	$616.60	$1,122.02
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $91.20 / $316.23 / $478.63	Professional	QX	$91.20	$316.23	$478.63
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $223.87 / $275.42 / $346.74	Professional	QY	$223.87	$275.42	$346.74
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $112.20 / $436.52 / $794.33	Professional	QZ	$112.20	$436.52	$794.33
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $69.18 / $69.18 / $72.44	Professional	QX	$69.18	$69.18	$72.44
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $97.72 / $165.96 / $199.53	Professional	QZ	$97.72	$165.96	$199.53
AmeriHealth Facility/Professional Professional Modifier QX Low / Median / High Price $37.15 / $77.62 / $208.93	Professional	QX	$37.15	$77.62	$208.93
AmeriHealth Facility/Professional Professional Modifier QY Low / Median / High Price $67.61 / $67.61 / $67.61	Professional	QY	$67.61	$67.61	$67.61
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $371.54 / $371.54 / $371.54	Facility		$371.54	$371.54	$371.54