Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $30.00 / $37.50 / $445.60	Facility		$30.00	$37.50	$445.60
Aetna Facility/Professional Facility Modifier AA Low / Median / High Price $505.92 / $505.92 / $505.92	Facility	AA	$505.92	$505.92	$505.92
Aetna Facility/Professional Facility Modifier QK Low / Median / High Price $243.10 / $512.72 / $654.50	Facility	QK	$243.10	$512.72	$654.50
Aetna Facility/Professional Facility Modifier QX Low / Median / High Price $157.08 / $422.24 / $742.56	Facility	QX	$157.08	$422.24	$742.56
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $147.53 / $665.20 / $945.95	Professional	AA	$147.53	$665.20	$945.95
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $125.55 / $480.25 / $734.93	Professional	QK	$125.55	$480.25	$734.93
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $97.50 / $502.08 / $916.84	Professional	QX	$97.50	$502.08	$916.84
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $91.50 / $396.97 / $531.17	Professional	QY	$91.50	$396.97	$531.17
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $244.80 / $340.80 / $650.72	Professional	QZ	$244.80	$340.80	$650.72
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $127.58 / $138.46 / $247.84	Professional	AA	$127.58	$138.46	$247.84
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $85.05 / $142.41 / $473.48	Professional	QK	$85.05	$142.41	$473.48
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $70.20 / $141.43 / $427.50	Professional	QX	$70.20	$141.43	$427.50
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $59.34 / $116.95 / $424.00	Professional	QY	$59.34	$116.95	$424.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $118.68 / $148.84 / $408.00	Professional	QZ	$118.68	$148.84	$408.00
BCBS Facility/Professional Professional Modifier AA Low / Median / High Price $175.00 / $292.50 / $425.90	Professional	AA	$175.00	$292.50	$425.90
BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $49.45 / $87.50 / $189.05	Professional	QX	$49.45	$87.50	$189.05
BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $140.00 / $200.00 / $302.50	Professional	QZ	$140.00	$200.00	$302.50
Medcost Facility/Professional Facility Modifier Low / Median / High Price $30.00 / $1,950.00 / $3,000.00	Facility		$30.00	$1,950.00	$3,000.00
United Facility/Professional Professional Modifier QX Low / Median / High Price $80.00 / $80.00 / $157.50	Professional	QX	$80.00	$80.00	$157.50