Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $232.98 / $1,400.00 / $2,100.00	Professional	AA	$232.98	$1,400.00	$2,100.00
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $539.38 / $694.45 / $885.08	Professional	QZ	$539.38	$694.45	$885.08
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $450.00 / $450.00 / $450.00	Professional	AA	$450.00	$450.00	$450.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $143.44 / $240.99 / $585.00	Professional	QZ	$143.44	$240.99	$585.00
Medica Facility/Professional Facility Modifier QK Low / Median / High Price $39.50 / $39.50 / $39.50	Facility	QK	$39.50	$39.50	$39.50
Medica Facility/Professional Facility Modifier QX Low / Median / High Price $39.50 / $39.50 / $39.50	Facility	QX	$39.50	$39.50	$39.50
Medica Facility/Professional Facility Modifier QY Low / Median / High Price $39.50 / $39.50 / $39.50	Facility	QY	$39.50	$39.50	$39.50
Qualchoice Facility/Professional Professional Modifier QZ Low / Median / High Price $410.55 / $410.55 / $410.55	Professional	QZ	$410.55	$410.55	$410.55