Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $25.12 / $147.91 / $602.56	Facility		$25.12	$147.91	$602.56
Aetna Facility/Professional Facility Modifier QK Low / Median / High Price $239.88 / $316.23 / $741.31	Facility	QK	$239.88	$316.23	$741.31
Aetna Facility/Professional Facility Modifier QX Low / Median / High Price $61.66 / $61.66 / $977.24	Facility	QX	$61.66	$61.66	$977.24
Aetna Facility/Professional Facility Modifier QY Low / Median / High Price $251.19 / $251.19 / $251.19	Facility	QY	$251.19	$251.19	$251.19
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $331.13 / $741.31 / $1,096.48	Professional	AA	$331.13	$741.31	$1,096.48
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $169.82 / $331.13 / $549.54	Professional	QK	$169.82	$331.13	$549.54
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $169.82 / $338.84 / $676.08	Professional	QX	$169.82	$338.84	$676.08
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $234.42 / $323.59 / $501.19	Professional	QY	$234.42	$323.59	$501.19
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $251.19 / $489.78 / $707.95	Professional	QZ	$251.19	$489.78	$707.95
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $117.49 / $138.04 / $389.05	Professional	AA	$117.49	$138.04	$389.05
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $60.26 / $89.13 / $190.55	Professional	QK	$60.26	$89.13	$190.55
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $58.88 / $83.18 / $229.09	Professional	QX	$58.88	$83.18	$229.09
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $61.66 / $63.10 / $85.11	Professional	QY	$61.66	$63.10	$85.11
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $117.49 / $138.04 / $309.03	Professional	QZ	$117.49	$138.04	$309.03
BCBS Facility/Professional Professional Modifier AA Low / Median / High Price $147.91 / $245.47 / $323.59	Professional	AA	$147.91	$245.47	$323.59
BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $39.81 / $83.18 / $154.88	Professional	QX	$39.81	$83.18	$154.88
BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $95.50 / $165.96 / $263.03	Professional	QZ	$95.50	$165.96	$263.03
Medcost Facility/Professional Facility Modifier Low / Median / High Price $50.12 / $2,570.40 / $5,623.41	Facility		$50.12	$2,570.40	$5,623.41