Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $588.84 / $870.96 / $1,479.11	Professional	AA	$588.84	$870.96	$1,479.11
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $338.84 / $602.56 / $758.58	Professional	QZ	$338.84	$602.56	$758.58
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $158.49 / $398.11 / $602.56	Professional	AA	$158.49	$398.11	$602.56
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $154.88 / $199.53 / $363.08	Professional	QZ	$154.88	$199.53	$363.08
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
Qualchoice Facility/Professional Professional Modifier AA Low / Median / High Price $524.81 / $524.81 / $524.81	Professional	AA	$524.81	$524.81	$524.81
Qualchoice Facility/Professional Professional Modifier QZ Low / Median / High Price $407.38 / $407.38 / $524.81	Professional	QZ	$407.38	$407.38	$524.81