Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $28.72 / $330.00 / $482.88	Facility		$28.72	$330.00	$482.88
Aetna Facility/Professional Facility Modifier QX Low / Median / High Price $91.20 / $99.96 / $223.72	Facility	QX	$91.20	$99.96	$223.72
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $1,242.59 / $1,242.59 / $1,242.59	Facility	QZ	$1,242.59	$1,242.59	$1,242.59
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $383.50 / $589.96 / $1,171.43	Professional	AA	$383.50	$589.96	$1,171.43
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $171.67 / $331.10 / $597.38	Professional	QK	$171.67	$331.10	$597.38
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $187.00 / $289.38 / $537.91	Professional	QX	$187.00	$289.38	$537.91
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $165.54 / $199.26 / $478.14	Professional	QY	$165.54	$199.26	$478.14
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $327.45 / $373.99 / $775.29	Professional	QZ	$327.45	$373.99	$775.29
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $135.59 / $201.47 / $455.00	Professional	AA	$135.59	$201.47	$455.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $76.75 / $104.88 / $174.80	Professional	QK	$76.75	$104.88	$174.80
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $66.56 / $110.82 / $170.56	Professional	QX	$66.56	$110.82	$170.56
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $93.29 / $193.94 / $196.65	Professional	QY	$93.29	$193.94	$196.65
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $135.59 / $174.33 / $279.58	Professional	QZ	$135.59	$174.33	$279.58
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
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $170.43 / $330.00 / $522.00	Professional		$170.43	$330.00	$522.00
Hally Health Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $100.00 / $100.00	Facility		$100.00	$100.00	$100.00
United Facility/Professional Professional Modifier AA Low / Median / High Price $75.00 / $582.00 / $1,445.60	Professional	AA	$75.00	$582.00	$1,445.60