Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $33.81 / $360.50 / $877.03	Facility		$33.81	$360.50	$877.03
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $99.55 / $99.55 / $99.55	Professional	AA	$99.55	$99.55	$99.55
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $160.68 / $253.71 / $286.81	Professional	QK	$160.68	$253.71	$286.81
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $138.32 / $224.30 / $268.42	Professional	QX	$138.32	$224.30	$268.42
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $183.57 / $231.65 / $261.07	Professional	QY	$183.57	$231.65	$261.07
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $345.98 / $372.10 / $385.15	Professional	QZ	$345.98	$372.10	$385.15
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $109.70 / $126.54 / $800.00	Professional	AA	$109.70	$126.54	$800.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $69.11 / $69.11 / $195.00	Professional	QK	$69.11	$69.11	$195.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $69.11 / $69.11 / $69.11	Professional	QX	$69.11	$69.11	$69.11
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $73.81 / $73.81 / $73.81	Professional	QY	$73.81	$73.81	$73.81
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $255.00 / $255.00 / $330.00	Professional	QZ	$255.00	$255.00	$330.00
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $664.80 / $664.80 / $664.80	Facility		$664.80	$664.80	$664.80
AmeriHealth Facility/Professional Professional Modifier QK Low / Median / High Price $64.75 / $128.00 / $216.00	Professional	QK	$64.75	$128.00	$216.00
AmeriHealth Facility/Professional Professional Modifier QX Low / Median / High Price $64.40 / $64.40 / $64.40	Professional	QX	$64.40	$64.40	$64.40
AmeriHealth Facility/Professional Professional Modifier QY Low / Median / High Price $272.70 / $272.70 / $272.70	Professional	QY	$272.70	$272.70	$272.70
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $300.00 / $300.00 / $300.00	Facility		$300.00	$300.00	$300.00