Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $58.79 / $390.00 / $534.05	Facility		$58.79	$390.00	$534.05
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $240.00 / $669.94 / $1,400.00	Professional	AA	$240.00	$669.94	$1,400.00
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $179.20 / $241.65 / $416.76	Professional	QK	$179.20	$241.65	$416.76
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $182.40 / $245.89 / $408.50	Professional	QX	$182.40	$245.89	$408.50
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $183.87 / $249.19 / $367.65	Professional	QY	$183.87	$249.19	$367.65
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $329.75 / $577.58 / $781.96	Professional	QZ	$329.75	$577.58	$781.96
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $152.54 / $350.00 / $400.00	Professional	AA	$152.54	$350.00	$400.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $65.37 / $98.95 / $204.00	Professional	QK	$65.37	$98.95	$204.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $67.87 / $126.46 / $260.00	Professional	QX	$67.87	$126.46	$260.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $60.27 / $118.97 / $270.00	Professional	QY	$60.27	$118.97	$270.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $127.98 / $190.18 / $455.00	Professional	QZ	$127.98	$190.18	$455.00
Medica Facility/Professional Facility Modifier Low / Median / High Price $42.84 / $2,615.98 / $3,041.64	Facility		$42.84	$2,615.98	$3,041.64
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
Qualchoice Facility/Professional Professional Modifier QK Low / Median / High Price $234.60 / $234.60 / $234.60	Professional	QK	$234.60	$234.60	$234.60
Qualchoice Facility/Professional Professional Modifier QX Low / Median / High Price $234.60 / $234.60 / $234.60	Professional	QX	$234.60	$234.60	$234.60
Qualchoice Facility/Professional Professional Modifier QZ Low / Median / High Price $136.69 / $351.90 / $469.20	Professional	QZ	$136.69	$351.90	$469.20