Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $551.00 / $744.00 / $943.51	Professional	QZ	$551.00	$744.00	$943.51
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $198.10 / $332.81 / $561.00	Professional	QZ	$198.10	$332.81	$561.00
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 $586.50 / $586.50 / $645.15	Professional	QZ	$586.50	$586.50	$645.15