Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $40.00 / $315.00 / $360.00	Facility		$40.00	$315.00	$360.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $248.00 / $316.00 / $364.00	Professional	AA	$248.00	$316.00	$364.00
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $140.00 / $146.00 / $190.00	Professional	QK	$140.00	$146.00	$190.00
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $190.00 / $190.00 / $190.00	Professional	QX	$190.00	$190.00	$190.00
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $128.00 / $150.00 / $160.00	Professional	QY	$128.00	$150.00	$160.00
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $588.00 / $840.00 / $995.40	Professional	QZ	$588.00	$840.00	$995.40
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $118.20 / $137.90 / $160.40	Professional	AA	$118.20	$137.90	$160.40
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $59.10 / $98.50 / $98.50	Professional	QK	$59.10	$98.50	$98.50
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $58.17 / $88.65 / $292.50	Professional	QX	$58.17	$88.65	$292.50
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $137.90 / $157.60 / $390.00	Professional	QZ	$137.90	$157.60	$390.00
Medica Facility/Professional Facility Modifier Low / Median / High Price $40.00 / $40.00 / $82.00	Facility		$40.00	$40.00	$82.00