Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $501.19 / $707.95 / $1,258.93	Professional	AA	$501.19	$707.95	$1,258.93
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $380.19 / $588.84 / $831.76	Professional	QZ	$380.19	$588.84	$831.76
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $141.25 / $302.00 / $446.68	Professional	AA	$141.25	$302.00	$446.68
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $144.54 / $204.17 / $407.38	Professional	QZ	$144.54	$204.17	$407.38
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 $467.74 / $467.74 / $467.74	Professional	AA	$467.74	$467.74	$467.74
Qualchoice Facility/Professional Professional Modifier QZ Low / Median / High Price $354.81 / $407.38 / $467.74	Professional	QZ	$354.81	$407.38	$467.74