Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $50.00 / $50.00 / $50.00	Facility		$50.00	$50.00	$50.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $136.61 / $1,120.00 / $1,960.00	Professional	AA	$136.61	$1,120.00	$1,960.00
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $75.87 / $315.83 / $385.06	Professional	QK	$75.87	$315.83	$385.06
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $75.87 / $315.83 / $360.00	Professional	QX	$75.87	$315.83	$360.00
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $333.14 / $333.14 / $367.75	Professional	QY	$333.14	$333.14	$367.75
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $129.40 / $129.40 / $693.00	Professional	QZ	$129.40	$129.40	$693.00
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $483.00 / $483.00 / $483.00	Professional	AA	$483.00	$483.00	$483.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $154.00 / $154.00 / $178.29	Professional	QZ	$154.00	$154.00	$178.29
BCBS Facility/Professional Facility Modifier Low / Median / High Price $56,799.99 / $68,899.99 / $81,099.99	Facility		$56,799.99	$68,899.99	$81,099.99
Providence Facility/Professional Professional Modifier QK Low / Median / High Price $174.00 / $233.10 / $243.00	Professional	QK	$174.00	$233.10	$243.00
Providence Facility/Professional Professional Modifier QX Low / Median / High Price $174.00 / $233.10 / $243.00	Professional	QX	$174.00	$233.10	$243.00
Providence Facility/Professional Professional Modifier QY Low / Median / High Price $174.00 / $233.10 / $243.00	Professional	QY	$174.00	$233.10	$243.00
United Facility/Professional Professional Modifier AA Low / Median / High Price $640.00 / $640.00 / $640.00	Professional	AA	$640.00	$640.00	$640.00
United Facility/Professional Professional Modifier QX Low / Median / High Price $85.00 / $85.00 / $85.00	Professional	QX	$85.00	$85.00	$85.00