Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $2,137.96 / $2,137.96 / $2,137.96	Facility	QZ	$2,137.96	$2,137.96	$2,137.96
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $588.84 / $891.25 / $1,548.82	Professional	AA	$588.84	$891.25	$1,548.82
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $457.09 / $660.69 / $891.25	Professional	QZ	$457.09	$660.69	$891.25
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $181.97 / $309.03 / $501.19	Professional	AA	$181.97	$309.03	$501.19
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $141.25 / $199.53 / $457.09	Professional	QZ	$141.25	$199.53	$457.09
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 $354.81 / $354.81 / $588.84	Professional	AA	$354.81	$354.81	$588.84
Qualchoice Facility/Professional Professional Modifier QZ Low / Median / High Price $354.81 / $645.65 / $707.95	Professional	QZ	$354.81	$645.65	$707.95