Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $35.00 / $121.50 / $283.50	Facility		$35.00	$121.50	$283.50
Aetna Facility/Professional Facility Modifier QX Low / Median / High Price $8.10 / $8.10 / $186.30	Facility	QX	$8.10	$8.10	$186.30
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $172.21 / $980.00 / $1,820.00	Professional	AA	$172.21	$980.00	$1,820.00
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $111.73 / $636.00 / $900.00	Professional	QK	$111.73	$636.00	$900.00
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $69.72 / $600.00 / $874.50	Professional	QX	$69.72	$600.00	$874.50
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $66.53 / $556.50 / $742.00	Professional	QY	$66.53	$556.50	$742.00
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $142.76 / $352.89 / $1,590.00	Professional	QZ	$142.76	$352.89	$1,590.00
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $140.77 / $721.00 / $1,106.00	Professional	AA	$140.77	$721.00	$1,106.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $80.23 / $316.00 / $520.00	Professional	QK	$80.23	$316.00	$520.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $70.14 / $228.00 / $846.00	Professional	QX	$70.14	$228.00	$846.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $780.00 / $780.00 / $780.00	Professional	QY	$780.00	$780.00	$780.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $112.22 / $385.00 / $910.00	Professional	QZ	$112.22	$385.00	$910.00
BCBS Facility/Professional Facility Modifier Low / Median / High Price $1.82 / $1.82 / $1.82	Facility		$1.82	$1.82	$1.82
Medica Facility/Professional Facility Modifier Low / Median / High Price $35.00 / $82.00 / $3,745.00	Facility		$35.00	$82.00	$3,745.00
Medica Facility/Professional Facility Modifier QK Low / Median / High Price $39.50 / $39.50 / $39.50	Facility	QK	$39.50	$39.50	$39.50
Medica Facility/Professional Facility Modifier QX Low / Median / High Price $39.50 / $39.50 / $39.50	Facility	QX	$39.50	$39.50	$39.50
Medica Facility/Professional Facility Modifier QY Low / Median / High Price $39.50 / $39.50 / $39.50	Facility	QY	$39.50	$39.50	$39.50
United Facility/Professional Professional Modifier AA Low / Median / High Price $75.00 / $582.00 / $1,445.60	Professional	AA	$75.00	$582.00	$1,445.60