Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $436.52 / $776.25 / $1,698.24	Professional	AA	$436.52	$776.25	$1,698.24
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $562.34 / $831.76 / $933.25	Professional	QZ	$562.34	$831.76	$933.25
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $309.03 / $309.03 / $354.81	Professional	AA	$309.03	$309.03	$354.81
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $104.71 / $165.96 / $616.60	Professional	QZ	$104.71	$165.96	$616.60
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 $407.38 / $407.38 / $407.38	Professional	AA	$407.38	$407.38	$407.38
Qualchoice Facility/Professional Professional Modifier QZ Low / Median / High Price $707.95 / $707.95 / $707.95	Professional	QZ	$707.95	$707.95	$707.95