Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier QX Low / Median / High Price $1,267.20 / $1,267.20 / $1,267.20	Facility	QX	$1,267.20	$1,267.20	$1,267.20
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $161.65 / $161.65 / $161.65	Facility	QZ	$161.65	$161.65	$161.65
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $172.30 / $703.10 / $1,530.00	Professional	AA	$172.30	$703.10	$1,530.00
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $201.50 / $311.89 / $441.18	Professional	QK	$201.50	$311.89	$441.18
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $158.66 / $275.89 / $459.73	Professional	QX	$158.66	$275.89	$459.73
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $197.72 / $359.48 / $476.91	Professional	QY	$197.72	$359.48	$476.91
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $382.80 / $678.11 / $801.13	Professional	QZ	$382.80	$678.11	$801.13
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $138.66 / $400.00 / $550.00	Professional	AA	$138.66	$400.00	$550.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $87.16 / $105.75 / $204.00	Professional	QK	$87.16	$105.75	$204.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $82.43 / $110.94 / $331.50	Professional	QX	$82.43	$110.94	$331.50
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $70.31 / $84.38 / $229.50	Professional	QY	$70.31	$84.38	$229.50
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $155.12 / $213.95 / $520.00	Professional	QZ	$155.12	$213.95	$520.00
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
Qualchoice Facility/Professional Professional Modifier QZ Low / Median / High Price $182.25 / $353.37 / $527.85	Professional	QZ	$182.25	$353.37	$527.85