Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $35.00 / $302.39 / $302.39	Facility		$35.00	$302.39	$302.39
Aetna Facility/Professional Facility Modifier QX Low / Median / High Price $251.10 / $251.10 / $340.20	Facility	QX	$251.10	$251.10	$340.20
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $1,410.08 / $1,410.08 / $1,410.08	Facility	QZ	$1,410.08	$1,410.08	$1,410.08
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $306.61 / $392.00 / $1,120.00	Professional	AA	$306.61	$392.00	$1,120.00
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $450.00 / $600.00 / $750.36	Professional	QK	$450.00	$600.00	$750.36
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $477.00 / $556.50 / $720.00	Professional	QX	$477.00	$556.50	$720.00
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $416.25 / $525.00 / $605.54	Professional	QY	$416.25	$525.00	$605.54
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $1,113.00 / $1,272.00 / $1,335.60	Professional	QZ	$1,113.00	$1,272.00	$1,335.60
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $140.77 / $540.00 / $1,040.00	Professional	AA	$140.77	$540.00	$1,040.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $70.20 / $70.20 / $70.20	Professional	QK	$70.20	$70.20	$70.20
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $50.10 / $171.00 / $752.00	Professional	QX	$50.10	$171.00	$752.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $455.00 / $455.00 / $455.00	Professional	QY	$455.00	$455.00	$455.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $80.16 / $240.00 / $555.00	Professional	QZ	$80.16	$240.00	$555.00
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