Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $181.97 / $275.42 / $446.68	Facility		$181.97	$275.42	$446.68
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $501.19 / $812.83 / $812.83	Facility	QZ	$501.19	$812.83	$812.83
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $128.82 / $691.83 / $1,148.15	Professional	AA	$128.82	$691.83	$1,148.15
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $177.83 / $338.84 / $588.84	Professional	QX	$177.83	$338.84	$588.84
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $223.87 / $288.40 / $446.68	Professional	QY	$223.87	$288.40	$446.68
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $269.15 / $512.86 / $676.08	Professional	QZ	$269.15	$512.86	$676.08
Cigna Facility/Professional Professional Modifier AA Low / Median / High Price $354.81 / $354.81 / $436.52	Professional	AA	$354.81	$354.81	$436.52
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $275.42 / $407.38	Professional		$213.80	$275.42	$407.38
Medica Facility/Professional Facility Modifier Low / Median / High Price $2,089.30 / $3,388.44 / $4,786.30	Facility		$2,089.30	$3,388.44	$4,786.30
Wellmark Facility/Professional Professional Modifier QX Low / Median / High Price $165.96 / $204.17 / $204.17	Professional	QX	$165.96	$204.17	$204.17