Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $40.00 / $798.00 / $993.70	Facility		$40.00	$798.00	$993.70
Aetna Facility/Professional Facility Modifier QX Low / Median / High Price $562.65 / $562.65 / $562.65	Facility	QX	$562.65	$562.65	$562.65
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $548.79 / $944.30 / $1,309.44	Professional	AA	$548.79	$944.30	$1,309.44
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $399.30 / $501.65 / $767.54	Professional	QK	$399.30	$501.65	$767.54
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $387.35 / $485.45 / $736.56	Professional	QX	$387.35	$485.45	$736.56
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $387.35 / $457.20 / $654.72	Professional	QY	$387.35	$457.20	$654.72
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $143.87 / $955.90 / $1,782.00	Professional	QZ	$143.87	$955.90	$1,782.00
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $145.11 / $497.52 / $1,300.00	Professional	AA	$145.11	$497.52	$1,300.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $100.50 / $393.40 / $585.00	Professional	QK	$100.50	$393.40	$585.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $74.45 / $436.00 / $846.00	Professional	QX	$74.45	$436.00	$846.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $93.29 / $367.50 / $585.00	Professional	QY	$93.29	$367.50	$585.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $127.98 / $786.80 / $1,040.00	Professional	QZ	$127.98	$786.80	$1,040.00
Cigna Facility/Professional Professional Modifier QK Low / Median / High Price $180.00 / $180.00 / $180.00	Professional	QK	$180.00	$180.00	$180.00
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 / $180.00	Professional	QY	$180.00	$180.00	$180.00
United Facility/Professional Professional Modifier AA Low / Median / High Price $75.00 / $75.00 / $640.00	Professional	AA	$75.00	$75.00	$640.00
United Facility/Professional Professional Modifier QX Low / Median / High Price $80.00 / $85.00 / $85.00	Professional	QX	$80.00	$85.00	$85.00
United Facility/Professional Professional Modifier QY Low / Median / High Price $189.00 / $189.00 / $189.00	Professional	QY	$189.00	$189.00	$189.00