Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $28.72 / $306.55 / $505.00	Facility		$28.72	$306.55	$505.00
Aetna Facility/Professional Facility Modifier QX Low / Median / High Price $97.60 / $176.12 / $262.30	Facility	QX	$97.60	$176.12	$262.30
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $1,254.18 / $1,254.18 / $2,106.92	Facility	QZ	$1,254.18	$1,254.18	$2,106.92
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $213.20 / $474.30 / $840.00	Professional	AA	$213.20	$474.30	$840.00
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $180.86 / $292.50 / $516.86	Professional	QK	$180.86	$292.50	$516.86
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $171.67 / $254.44 / $502.32	Professional	QX	$171.67	$254.44	$502.32
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $187.00 / $211.52 / $398.25	Professional	QY	$187.00	$211.52	$398.25
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $200.90 / $373.99 / $836.00	Professional	QZ	$200.90	$373.99	$836.00
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $116.22 / $176.99 / $298.48	Professional	AA	$116.22	$176.99	$298.48
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $72.11 / $91.77 / $131.10	Professional	QK	$72.11	$91.77	$131.10
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $10.65 / $103.73 / $174.80	Professional	QX	$10.65	$103.73	$174.80
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $59.37 / $82.92 / $174.80	Professional	QY	$59.37	$82.92	$174.80
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $116.22 / $149.24 / $409.50	Professional	QZ	$116.22	$149.24	$409.50
Cigna Facility/Professional Professional Modifier QK Low / Median / High Price $150.00 / $150.00 / $150.00	Professional	QK	$150.00	$150.00	$150.00
Cigna Facility/Professional Professional Modifier QX Low / Median / High Price $150.00 / $150.00 / $150.00	Professional	QX	$150.00	$150.00	$150.00
Cigna Facility/Professional Professional Modifier QY Low / Median / High Price $150.00 / $150.00 / $150.00	Professional	QY	$150.00	$150.00	$150.00
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $142.03 / $275.00 / $435.00	Professional		$142.03	$275.00	$435.00
Hally Health Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $100.00 / $100.00	Facility		$100.00	$100.00	$100.00