Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $980.00 / $1,540.00 / $2,800.00	Professional	AA	$980.00	$1,540.00	$2,800.00
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $220.61 / $724.21 / $1,346.15	Professional	QX	$220.61	$724.21	$1,346.15
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $423.80 / $552.54 / $749.48	Professional	QY	$423.80	$552.54	$749.48
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $369.60 / $502.67 / $973.00	Professional	QZ	$369.60	$502.67	$973.00
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $459.00 / $861.60 / $867.00	Professional	AA	$459.00	$861.60	$867.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $97.55 / $294.76 / $455.00	Professional	QX	$97.55	$294.76	$455.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $280.00 / $280.00 / $525.00	Professional	QY	$280.00	$280.00	$525.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $195.10 / $312.16 / $663.00	Professional	QZ	$195.10	$312.16	$663.00
Cigna Facility/Professional Professional Modifier QX Low / Median / High Price $180.00 / $180.00 / $180.00	Professional	QX	$180.00	$180.00	$180.00
Cigna Facility/Professional Professional Modifier QY Low / Median / High Price $180.00 / $180.00 / $360.00	Professional	QY	$180.00	$180.00	$360.00
Lucent Health Facility/Professional Facility Modifier QK Low / Median / High Price $37.00 / $37.00 / $39.50	Facility	QK	$37.00	$37.00	$39.50
Lucent Health Facility/Professional Facility Modifier QX Low / Median / High Price $37.00 / $37.00 / $39.50	Facility	QX	$37.00	$37.00	$39.50
Lucent Health Facility/Professional Facility Modifier QY Low / Median / High Price $37.00 / $37.00 / $39.50	Facility	QY	$37.00	$37.00	$39.50