Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $42.00 / $210.00 / $310.00	Facility		$42.00	$210.00	$310.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $105.74 / $505.75 / $650.25	Professional	AA	$105.74	$505.75	$650.25
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $119.00 / $186.00 / $361.25	Professional	QK	$119.00	$186.00	$361.25
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $145.69 / $195.30 / $229.40	Professional	QX	$145.69	$195.30	$229.40
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $216.75 / $216.75 / $216.75	Professional	QY	$216.75	$216.75	$216.75
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $105.35 / $308.00 / $608.29	Professional	QZ	$105.35	$308.00	$608.29
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $167.48 / $306.00 / $357.00	Professional	AA	$167.48	$306.00	$357.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $113.16 / $165.00 / $255.00	Professional	QK	$113.16	$165.00	$255.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $110.65 / $178.50 / $229.50	Professional	QX	$110.65	$178.50	$229.50
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $153.00 / $302.50 / $302.50	Professional	QY	$153.00	$302.50	$302.50
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $255.00 / $345.00 / $473.28	Professional	QZ	$255.00	$345.00	$473.28
Qualchoice Facility/Professional Professional Modifier AA Low / Median / High Price $351.90 / $351.90 / $410.55	Professional	AA	$351.90	$351.90	$410.55
Qualchoice Facility/Professional Professional Modifier QK Low / Median / High Price $189.75 / $189.75 / $189.75	Professional	QK	$189.75	$189.75	$189.75
Qualchoice Facility/Professional Professional Modifier QX Low / Median / High Price $146.63 / $234.60 / $263.93	Professional	QX	$146.63	$234.60	$263.93
Qualchoice Facility/Professional Professional Modifier QY Low / Median / High Price $347.88 / $347.88 / $347.88	Professional	QY	$347.88	$347.88	$347.88
Qualchoice Facility/Professional Professional Modifier QZ Low / Median / High Price $351.90 / $410.55 / $550.62	Professional	QZ	$351.90	$410.55	$550.62