Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $522.89 / $833.52 / $1,680.00	Professional	AA	$522.89	$833.52	$1,680.00
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $388.60 / $523.83 / $793.20	Professional	QZ	$388.60	$523.83	$793.20
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $290.80 / $450.00 / $700.00	Professional	AA	$290.80	$450.00	$700.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $155.12 / $254.90 / $585.00	Professional	QZ	$155.12	$254.90	$585.00
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 $469.20 / $586.50 / $645.15	Professional	QZ	$469.20	$586.50	$645.15