Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $251.19 / $251.19 / $251.19	Facility	QZ	$251.19	$251.19	$251.19
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $338.84 / $616.60 / $1,412.54	Professional	AA	$338.84	$616.60	$1,412.54
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $104.71 / $257.04 / $549.54	Professional	AA	$104.71	$257.04	$549.54
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 $295.12 / $295.12 / $407.38	Professional	AA	$295.12	$295.12	$407.38