Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $33.81 / $33.81 / $844.01	Facility		$33.81	$33.81	$844.01
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $980.00 / $1,150.58 / $1,613.45	Professional	AA	$980.00	$1,150.58	$1,613.45
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $55.28 / $253.71 / $279.45	Professional	QK	$55.28	$253.71	$279.45
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $187.00 / $239.01 / $274.52	Professional	QX	$187.00	$239.01	$274.52
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $57.12 / $216.94 / $268.42	Professional	QY	$57.12	$216.94	$268.42
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $345.98 / $345.98 / $385.15	Professional	QZ	$345.98	$345.98	$385.15
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $126.54 / $149.94 / $625.00	Professional	AA	$126.54	$149.94	$625.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $560.00 / $560.00 / $560.00	Professional	QX	$560.00	$560.00	$560.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $63.27 / $63.27 / $63.27	Professional	QY	$63.27	$63.27	$63.27
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $275.00 / $275.00 / $306.00	Professional	QZ	$275.00	$275.00	$306.00
AmeriHealth Facility/Professional Professional Modifier QK Low / Median / High Price $51.80 / $51.80 / $63.00	Professional	QK	$51.80	$51.80	$63.00
AmeriHealth Facility/Professional Professional Modifier QX Low / Median / High Price $61.88 / $61.88 / $61.88	Professional	QX	$61.88	$61.88	$61.88
AmeriHealth Facility/Professional Professional Modifier QY Low / Median / High Price $143.00 / $143.00 / $143.00	Professional	QY	$143.00	$143.00	$143.00
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $375.00 / $375.00 / $375.00	Facility		$375.00	$375.00	$375.00