Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $575.44 / $1,096.48 / $1,548.82	Professional	AA	$575.44	$1,096.48	$1,548.82
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $281.84 / $416.87 / $724.44	Professional	QK	$281.84	$416.87	$724.44
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $295.12 / $426.58 / $741.31	Professional	QX	$295.12	$426.58	$741.31
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $316.23 / $416.87 / $776.25	Professional	QY	$316.23	$416.87	$776.25
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $416.87 / $676.08 / $1,412.54	Professional	QZ	$416.87	$676.08	$1,412.54
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $141.25 / $562.34 / $1,174.90	Professional	AA	$141.25	$562.34	$1,174.90
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $89.13 / $128.82 / $281.84	Professional	QK	$89.13	$128.82	$281.84
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $77.62 / $97.72 / $295.12	Professional	QX	$77.62	$97.72	$295.12
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $79.43 / $87.10 / $112.20	Professional	QY	$79.43	$87.10	$112.20
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $154.88 / $181.97 / $630.96	Professional	QZ	$154.88	$181.97	$630.96
Medica Facility/Professional Facility Modifier QK Low / Median / High Price $39.81 / $39.81 / $39.81	Facility	QK	$39.81	$39.81	$39.81
Medica Facility/Professional Facility Modifier QX Low / Median / High Price $39.81 / $39.81 / $39.81	Facility	QX	$39.81	$39.81	$39.81
Medica Facility/Professional Facility Modifier QY Low / Median / High Price $39.81 / $39.81 / $39.81	Facility	QY	$39.81	$39.81	$39.81