Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $186.60 / $186.60 / $186.60	Facility	QZ	$186.60	$186.60	$186.60
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $440.08 / $790.56 / $1,960.00	Professional	AA	$440.08	$790.56	$1,960.00
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $382.80 / $580.07 / $896.32	Professional	QZ	$382.80	$580.07	$896.32
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $142.63 / $300.00 / $500.00	Professional	AA	$142.63	$300.00	$500.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $138.66 / $208.55 / $459.00	Professional	QZ	$138.66	$208.55	$459.00
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 $159.47 / $182.25 / $469.20	Professional	QZ	$159.47	$182.25	$469.20