Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $35.00 / $275.00 / $275.00	Facility		$35.00	$275.00	$275.00
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $552.90 / $552.90 / $552.90	Facility	QZ	$552.90	$552.90	$552.90
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $127.22 / $127.22 / $127.22	Professional	AA	$127.22	$127.22	$127.22
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $172.50 / $177.50 / $189.75	Professional	QX	$172.50	$177.50	$189.75
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $114.41 / $529.20 / $610.54	Professional	QZ	$114.41	$529.20	$610.54
Cigna Facility/Professional Professional Modifier AA Low / Median / High Price $342.85 / $404.25 / $428.56	Professional	AA	$342.85	$404.25	$428.56
Medica Facility/Professional Facility Modifier Low / Median / High Price $2,750.00 / $2,750.00 / $3,700.00	Facility		$2,750.00	$2,750.00	$3,700.00
Wellmark Facility/Professional Professional Modifier AA Low / Median / High Price $370.00 / $370.00 / $370.00	Professional	AA	$370.00	$370.00	$370.00
Wellmark Facility/Professional Professional Modifier QX Low / Median / High Price $166.25 / $185.00 / $205.00	Professional	QX	$166.25	$185.00	$205.00
Wellmark Facility/Professional Professional Modifier QZ Low / Median / High Price $288.50 / $288.50 / $288.50	Professional	QZ	$288.50	$288.50	$288.50