Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $630.96 / $1,148.15 / $2,398.83	Professional	AA	$630.96	$1,148.15	$2,398.83
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $380.19 / $630.96 / $933.25	Professional	QX	$380.19	$630.96	$933.25
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $316.23 / $602.56 / $977.24	Professional	QY	$316.23	$602.56	$977.24
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $537.03 / $912.01 / $1,318.26	Professional	QZ	$537.03	$912.01	$1,318.26
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $162.18 / $407.38 / $616.60	Professional	AA	$162.18	$407.38	$616.60
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $81.28 / $158.49 / $436.52	Professional	QX	$81.28	$158.49	$436.52
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $85.11 / $95.50 / $204.17	Professional	QY	$85.11	$95.50	$204.17
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $194.98 / $288.40 / $645.65	Professional	QZ	$194.98	$288.40	$645.65
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 $467.74 / $467.74 / $467.74	Professional	AA	$467.74	$467.74	$467.74
Qualchoice Facility/Professional Professional Modifier QZ Low / Median / High Price $588.84 / $588.84 / $812.83	Professional	QZ	$588.84	$588.84	$812.83