Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $537.03 / $954.99 / $1,819.70	Professional	AA	$537.03	$954.99	$1,819.70
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $489.78 / $812.83 / $1,148.15	Professional	QZ	$489.78	$812.83	$1,148.15
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $190.55 / $309.03 / $645.65	Professional	AA	$190.55	$309.03	$645.65
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $194.98 / $281.84 / $616.60	Professional	QZ	$194.98	$281.84	$616.60
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 / $645.65	Professional	AA	$524.81	$524.81	$645.65
Qualchoice Facility/Professional Professional Modifier QZ Low / Median / High Price $467.74 / $588.84 / $870.96	Professional	QZ	$467.74	$588.84	$870.96