Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $40.00 / $262.50 / $300.00	Facility		$40.00	$262.50	$300.00
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $663.60 / $663.60 / $663.60	Professional	QZ	$663.60	$663.60	$663.60
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $100.25 / $131.01 / $137.90	Professional	AA	$100.25	$131.01	$137.90
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $50.13 / $50.13 / $50.13	Professional	QX	$50.13	$50.13	$50.13
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $50.13 / $50.13 / $50.13	Professional	QY	$50.13	$50.13	$50.13
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $98.50 / $118.20 / $197.00	Professional	QZ	$98.50	$118.20	$197.00
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,360.00 / $1,600.00 / $1,802.00	Facility		$1,360.00	$1,600.00	$1,802.00