Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $700.00 / $1,540.00 / $2,800.00	Professional	AA	$700.00	$1,540.00	$2,800.00
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $225.00 / $381.30 / $551.48	Professional	QX	$225.00	$381.30	$551.48
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $539.38 / $866.02 / $1,332.58	Professional	QZ	$539.38	$866.02	$1,332.58
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $370.12 / $400.00 / $700.00	Professional	AA	$370.12	$400.00	$700.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $96.95 / $292.50 / $382.50	Professional	QX	$96.95	$292.50	$382.50
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $185.06 / $185.06 / $237.12	Professional	QY	$185.06	$185.06	$237.12
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $118.86 / $370.76 / $612.00	Professional	QZ	$118.86	$370.76	$612.00
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 $703.80 / $703.80 / $762.45	Professional	QZ	$703.80	$703.80	$762.45