Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $42.00 / $252.00 / $372.00	Facility		$42.00	$252.00	$372.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $433.50 / $650.25 / $1,083.75	Professional	AA	$433.50	$650.25	$1,083.75
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $185.60 / $231.00 / $361.25	Professional	QK	$185.60	$231.00	$361.25
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $173.25 / $208.00 / $272.80	Professional	QX	$173.25	$208.00	$272.80
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $252.88 / $289.00 / $433.50	Professional	QY	$252.88	$289.00	$433.50
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $119.36 / $330.40 / $794.75	Professional	QZ	$119.36	$330.40	$794.75
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $234.47 / $360.57 / $495.00	Professional	AA	$234.47	$360.57	$495.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $178.50 / $204.00 / $275.00	Professional	QK	$178.50	$204.00	$275.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $105.00 / $204.00 / $229.50	Professional	QX	$105.00	$204.00	$229.50
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $255.00 / $255.00 / $255.00	Professional	QY	$255.00	$255.00	$255.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $306.00 / $357.00 / $473.28	Professional	QZ	$306.00	$357.00	$473.28
Qualchoice Facility/Professional Professional Modifier AA Low / Median / High Price $469.20 / $471.96 / $727.38	Professional	AA	$469.20	$471.96	$727.38
Qualchoice Facility/Professional Professional Modifier QK Low / Median / High Price $205.28 / $205.28 / $316.25	Professional	QK	$205.28	$205.28	$316.25
Qualchoice Facility/Professional Professional Modifier QX Low / Median / High Price $234.60 / $234.60 / $263.93	Professional	QX	$234.60	$234.60	$263.93
Qualchoice Facility/Professional Professional Modifier QY Low / Median / High Price $234.60 / $234.60 / $293.25	Professional	QY	$234.60	$234.60	$293.25
Qualchoice Facility/Professional Professional Modifier QZ Low / Median / High Price $351.90 / $410.55 / $550.62	Professional	QZ	$351.90	$410.55	$550.62