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 $792.00 / $792.00 / $792.00	Facility	QX	$792.00	$792.00	$792.00
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $107.77 / $107.77 / $107.77	Facility	QZ	$107.77	$107.77	$107.77
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $244.00 / $423.40 / $980.00	Professional	AA	$244.00	$423.40	$980.00
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $167.40 / $195.30 / $251.10	Professional	QK	$167.40	$195.30	$251.10
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $88.44 / $182.90 / $260.62	Professional	QX	$88.44	$182.90	$260.62
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $158.10 / $253.49 / $253.49	Professional	QY	$158.10	$253.49	$253.49
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $319.00 / $567.14 / $727.13	Professional	QZ	$319.00	$567.14	$727.13
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $108.96 / $300.00 / $350.00	Professional	AA	$108.96	$300.00	$350.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $50.23 / $67.87 / $153.00	Professional	QK	$50.23	$67.87	$153.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $58.88 / $79.31 / $153.00	Professional	QX	$58.88	$79.31	$153.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $50.23 / $58.17 / $79.31	Professional	QY	$50.23	$58.17	$79.31
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $99.05 / $142.63 / $390.00	Professional	QZ	$99.05	$142.63	$390.00
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 $146.63 / $146.63 / $146.63	Professional	QX	$146.63	$146.63	$146.63
Qualchoice Facility/Professional Professional Modifier QZ Low / Median / High Price $136.69 / $196.32 / $351.90	Professional	QZ	$136.69	$196.32	$351.90