Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $172.06 / $830.00 / $1,540.00	Professional	AA	$172.06	$830.00	$1,540.00
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $93.19 / $740.00 / $960.00	Professional	QK	$93.19	$740.00	$960.00
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $555.00 / $720.00 / $971.25	Professional	QX	$555.00	$720.00	$971.25
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $624.37 / $720.00 / $825.00	Professional	QY	$624.37	$720.00	$825.00
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $399.17 / $1,356.80 / $1,749.00	Professional	QZ	$399.17	$1,356.80	$1,749.00
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $200.40 / $720.00 / $1,300.00	Professional	AA	$200.40	$720.00	$1,300.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $90.27 / $300.00 / $316.00	Professional	QK	$90.27	$300.00	$316.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $85.17 / $256.50 / $658.00	Professional	QX	$85.17	$256.50	$658.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $585.00 / $585.00 / $585.00	Professional	QY	$585.00	$585.00	$585.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $112.22 / $440.00 / $700.00	Professional	QZ	$112.22	$440.00	$700.00
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