Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $346.74 / $616.60 / $1,174.90	Facility		$346.74	$616.60	$1,174.90
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $380.19 / $691.83 / $1,174.90	Professional	AA	$380.19	$691.83	$1,174.90
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $218.78 / $354.81 / $537.03	Professional	QK	$218.78	$354.81	$537.03
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $218.78 / $346.74 / $537.03	Professional	QX	$218.78	$346.74	$537.03
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $218.78 / $302.00 / $436.52	Professional	QY	$218.78	$302.00	$436.52
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $331.13 / $537.03 / $851.14	Professional	QZ	$331.13	$537.03	$851.14
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $117.49 / $162.18 / $1,122.02	Professional	AA	$117.49	$162.18	$1,122.02
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $60.26 / $66.07 / $89.13	Professional	QK	$60.26	$66.07	$89.13
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $60.26 / $77.62 / $562.34	Professional	QX	$60.26	$77.62	$562.34
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $120.23 / $173.78 / $234.42	Professional	QZ	$120.23	$173.78	$234.42
AmeriHealth Facility/Professional Professional Modifier QK Low / Median / High Price $51.29 / $51.29 / $63.10	Professional	QK	$51.29	$51.29	$63.10
AmeriHealth Facility/Professional Professional Modifier QX Low / Median / High Price $61.66 / $61.66 / $61.66	Professional	QX	$61.66	$61.66	$61.66
AmeriHealth Facility/Professional Professional Modifier QY Low / Median / High Price $144.54 / $144.54 / $144.54	Professional	QY	$144.54	$144.54	$144.54
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $371.54 / $371.54 / $371.54	Facility		$371.54	$371.54	$371.54