Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $42.00 / $48.00 / $310.00	Facility		$42.00	$48.00	$310.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $389.58 / $389.58 / $389.58	Professional	AA	$389.58	$389.58	$389.58
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $164.30 / $186.00 / $251.10	Professional	QK	$164.30	$186.00	$251.10
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $148.50 / $182.40 / $229.40	Professional	QX	$148.50	$182.40	$229.40
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $158.10 / $158.10 / $158.10	Professional	QY	$158.10	$158.10	$158.10
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $99.50 / $308.00 / $455.60	Professional	QZ	$99.50	$308.00	$455.60
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $204.00 / $306.00 / $357.00	Professional	AA	$204.00	$306.00	$357.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $137.50 / $137.50 / $153.00	Professional	QK	$137.50	$137.50	$153.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $94.85 / $127.50 / $178.50	Professional	QX	$94.85	$127.50	$178.50
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $165.00 / $165.00 / $165.00	Professional	QY	$165.00	$165.00	$165.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $189.69 / $287.50 / $345.00	Professional	QZ	$189.69	$287.50	$345.00
Qualchoice Facility/Professional Professional Modifier AA Low / Median / High Price $293.25 / $351.90 / $410.55	Professional	AA	$293.25	$351.90	$410.55
Qualchoice Facility/Professional Professional Modifier QK Low / Median / High Price $158.13 / $158.13 / $158.13	Professional	QK	$158.13	$158.13	$158.13
Qualchoice Facility/Professional Professional Modifier QX Low / Median / High Price $132.25 / $146.63 / $205.28	Professional	QX	$132.25	$146.63	$205.28
Qualchoice Facility/Professional Professional Modifier QY Low / Median / High Price $189.75 / $189.75 / $189.75	Professional	QY	$189.75	$189.75	$189.75
Qualchoice Facility/Professional Professional Modifier QZ Low / Median / High Price $293.25 / $345.00 / $393.30	Professional	QZ	$293.25	$345.00	$393.30