Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $210.00 / $325.00 / $445.05	Facility		$210.00	$325.00	$445.05
Aetna Facility/Professional Facility Modifier QX Low / Median / High Price $231.90 / $231.90 / $231.90	Facility	QX	$231.90	$231.90	$231.90
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $118.74 / $118.74 / $118.74	Facility	QZ	$118.74	$118.74	$118.74
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $147.61 / $497.70 / $1,157.86	Professional	AA	$147.61	$497.70	$1,157.86
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $119.00 / $186.00 / $277.70	Professional	QK	$119.00	$186.00	$277.70
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $64.78 / $201.50 / $365.20	Professional	QX	$64.78	$201.50	$365.20
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $270.68 / $316.80 / $490.20	Professional	QY	$270.68	$316.80	$490.20
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $324.80 / $555.24 / $710.79	Professional	QZ	$324.80	$555.24	$710.79
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $158.32 / $300.00 / $500.00	Professional	AA	$158.32	$300.00	$500.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $58.17 / $84.55 / $153.00	Professional	QK	$58.17	$84.55	$153.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $58.17 / $92.53 / $195.00	Professional	QX	$58.17	$92.53	$195.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $59.37 / $79.31 / $79.31	Professional	QY	$59.37	$79.31	$79.31
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $118.86 / $166.40 / $408.00	Professional	QZ	$118.86	$166.40	$408.00
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 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 $159.47 / $351.90 / $410.55	Professional	QZ	$159.47	$351.90	$410.55