Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $41.69 / $371.54 / $512.86	Facility		$41.69	$371.54	$512.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $50.12 / $616.60	Professional		$32.36	$50.12	$616.60
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $794.33 / $794.33 / $794.33	Professional	AA	$794.33	$794.33	$794.33
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $269.15 / $426.58 / $575.44	Professional	QX	$269.15	$426.58	$575.44
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $295.12 / $309.03 / $489.78	Professional	QY	$295.12	$309.03	$489.78
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $120.23 / $138.04 / $436.52	Professional	QZ	$120.23	$138.04	$436.52
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $60.26 / $60.26 / $151.36	Professional	QX	$60.26	$60.26	$151.36
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $204.17 / $204.17 / $204.17	Professional	QY	$204.17	$204.17	$204.17
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $117.49 / $144.54 / $354.81	Professional	QZ	$117.49	$144.54	$354.81
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $323.59 / $457.09	Professional		$263.03	$323.59	$457.09
BCBS Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $54.95 / $58.88	Professional		$51.29	$54.95	$58.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $302.00 / $407.38	Professional		$199.53	$302.00	$407.38
Medica Facility/Professional Facility Modifier Low / Median / High Price $81.28 / $2,754.23 / $3,235.94	Facility		$81.28	$2,754.23	$3,235.94
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
Medica Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $58.88 / $1,348.96	Professional		$39.81	$58.88	$1,348.96
Qualchoice Facility/Professional Professional Modifier QX Low / Median / High Price $177.83 / $177.83 / $177.83	Professional	QX	$177.83	$177.83	$177.83
Qualchoice Facility/Professional Professional Modifier QZ Low / Median / High Price $354.81 / $354.81 / $407.38	Professional	QZ	$354.81	$354.81	$407.38
United Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $54.95 / $75.86	Professional		$38.90	$54.95	$75.86