Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier QX Low / Median / High Price $389.05 / $6,165.95 / $6,165.95	Facility	QX	$389.05	$6,165.95	$6,165.95
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $1,348.96 / $2,089.30 / $2,951.21	Professional	AA	$1,348.96	$2,089.30	$2,951.21
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $1,174.90 / $1,174.90 / $1,174.90	Professional	QZ	$1,174.90	$1,174.90	$1,174.90
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $316.23 / $912.01 / $1,174.90	Professional	AA	$316.23	$912.01	$1,174.90
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $194.98 / $275.42 / $758.58	Professional	QZ	$194.98	$275.42	$758.58
Wellcare Facility/Professional Facility Modifier QK Low / Median / High Price $52.48 / $52.48 / $52.48	Facility	QK	$52.48	$52.48	$52.48
Wellcare Facility/Professional Facility Modifier QX Low / Median / High Price $52.48 / $52.48 / $52.48	Facility	QX	$52.48	$52.48	$52.48
Wellcare Facility/Professional Facility Modifier QY Low / Median / High Price $52.48 / $52.48 / $52.48	Facility	QY	$52.48	$52.48	$52.48