Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $41.69 / $323.59 / $446.68	Facility		$41.69	$323.59	$446.68
Aetna Facility/Professional Facility Modifier QX Low / Median / High Price $234.42 / $234.42 / $234.42	Facility	QX	$234.42	$234.42	$234.42
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $117.49 / $117.49 / $117.49	Facility	QZ	$117.49	$117.49	$117.49
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $288.40 / $602.56 / $1,122.02	Professional	AA	$288.40	$602.56	$1,122.02
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $112.20 / $316.23 / $512.86	Professional	QK	$112.20	$316.23	$512.86
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $177.83 / $323.59 / $501.19	Professional	QX	$177.83	$323.59	$501.19
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $239.88 / $295.12 / $467.74	Professional	QY	$239.88	$295.12	$467.74
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $302.00 / $537.03 / $707.95	Professional	QZ	$302.00	$537.03	$707.95
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $120.23 / $302.00 / $389.05	Professional	AA	$120.23	$302.00	$389.05
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $57.54 / $79.43 / $295.12	Professional	QK	$57.54	$79.43	$295.12
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $58.88 / $74.13 / $177.83	Professional	QX	$58.88	$74.13	$177.83
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $48.98 / $61.66 / $194.98	Professional	QY	$48.98	$61.66	$194.98
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $117.49 / $141.25 / $354.81	Professional	QZ	$117.49	$141.25	$354.81
Medica Facility/Professional Facility Modifier Low / Median / High Price $42.66 / $83.18 / $3,019.95	Facility		$42.66	$83.18	$3,019.95
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
Qualchoice Facility/Professional Professional Modifier AA Low / Median / High Price $354.81 / $354.81 / $354.81	Professional	AA	$354.81	$354.81	$354.81
Qualchoice Facility/Professional Professional Modifier QZ Low / Median / High Price $354.81 / $354.81 / $407.38	Professional	QZ	$354.81	$354.81	$407.38