Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $537.03 / $912.01 / $1,862.09	Professional	AA	$537.03	$912.01	$1,862.09
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $446.68 / $691.83 / $1,202.26	Professional	QZ	$446.68	$691.83	$1,202.26
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $147.91 / $380.19 / $851.14	Professional	AA	$147.91	$380.19	$851.14
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $144.54 / $269.15 / $512.86	Professional	QZ	$144.54	$269.15	$512.86
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 / $588.84	Professional	AA	$524.81	$524.81	$588.84
Qualchoice Facility/Professional Professional Modifier QZ Low / Median / High Price $354.81 / $407.38 / $588.84	Professional	QZ	$354.81	$407.38	$588.84