Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $630.96 / $1,000.00 / $1,513.56	Professional	AA	$630.96	$1,000.00	$1,513.56
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $263.03 / $446.68 / $794.33	Professional	QK	$263.03	$446.68	$794.33
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $213.80 / $426.58 / $758.58	Professional	QX	$213.80	$426.58	$758.58
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $295.12 / $416.87 / $758.58	Professional	QY	$295.12	$416.87	$758.58
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $416.87 / $691.83 / $1,348.96	Professional	QZ	$416.87	$691.83	$1,348.96
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $169.82 / $218.78 / $275.42	Professional	AA	$169.82	$218.78	$275.42
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $81.28 / $102.33 / $165.96	Professional	QK	$81.28	$102.33	$165.96
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $60.26 / $81.28 / $125.89	Professional	QX	$60.26	$81.28	$125.89
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $74.13 / $85.11 / $141.25	Professional	QY	$74.13	$85.11	$141.25
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $141.25 / $186.21 / $309.03	Professional	QZ	$141.25	$186.21	$309.03
BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $190.55 / $213.80 / $213.80	Professional	QX	$190.55	$213.80	$213.80
BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $363.08 / $407.38 / $407.38	Professional	QZ	$363.08	$407.38	$407.38
Health Alliance Plan Facility/Professional Professional Modifier AA Low / Median / High Price $630.96 / $1,000.00 / $1,548.82	Professional	AA	$630.96	$1,000.00	$1,548.82
Health Alliance Plan Facility/Professional Professional Modifier QK Low / Median / High Price $263.03 / $467.74 / $794.33	Professional	QK	$263.03	$467.74	$794.33
Health Alliance Plan Facility/Professional Professional Modifier QX Low / Median / High Price $208.93 / $446.68 / $776.25	Professional	QX	$208.93	$446.68	$776.25
Health Alliance Plan Facility/Professional Professional Modifier QY Low / Median / High Price $269.15 / $457.09 / $891.25	Professional	QY	$269.15	$457.09	$891.25
Health Alliance Plan Facility/Professional Professional Modifier QZ Low / Median / High Price $416.87 / $645.65 / $1,071.52	Professional	QZ	$416.87	$645.65	$1,071.52