Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $34.67 / $34.67 / $34.67	Facility		$34.67	$34.67	$34.67
Aetna Facility/Professional Facility Modifier QX Low / Median / High Price $331.13 / $436.52 / $645.65	Facility	QX	$331.13	$436.52	$645.65
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $346.74 / $346.74 / $346.74	Facility	QZ	$346.74	$346.74	$346.74
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $380.19 / $831.76 / $1,258.93	Professional	AA	$380.19	$831.76	$1,258.93
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $223.87 / $338.84 / $645.65	Professional	QK	$223.87	$338.84	$645.65
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $234.42 / $346.74 / $630.96	Professional	QX	$234.42	$346.74	$630.96
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $245.47 / $316.23 / $630.96	Professional	QY	$245.47	$316.23	$630.96
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $354.81 / $575.44 / $1,122.02	Professional	QZ	$354.81	$575.44	$1,122.02
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $120.23 / $416.87 / $870.96	Professional	AA	$120.23	$416.87	$870.96
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $67.61 / $89.13 / $331.13	Professional	QK	$67.61	$89.13	$331.13
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $67.61 / $89.13 / $316.23	Professional	QX	$67.61	$89.13	$316.23
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $100.00 / $128.82 / $229.09	Professional	QY	$100.00	$128.82	$229.09
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $109.65 / $147.91 / $398.11	Professional	QZ	$109.65	$147.91	$398.11
Medica Facility/Professional Facility Modifier Low / Median / High Price $34.67 / $81.28 / $3,715.35	Facility		$34.67	$81.28	$3,715.35
Medica Facility/Professional Facility Modifier QK Low / Median / High Price $39.81 / $39.81 / $39.81	Facility	QK	$39.81	$39.81	$39.81
Medica Facility/Professional Facility Modifier QX Low / Median / High Price $39.81 / $39.81 / $39.81	Facility	QX	$39.81	$39.81	$39.81
Medica Facility/Professional Facility Modifier QY Low / Median / High Price $39.81 / $39.81 / $39.81	Facility	QY	$39.81	$39.81	$39.81