Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $169.99 / $1,400.00 / $1,820.00	Professional	AA	$169.99	$1,400.00	$1,820.00
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $216.10 / $1,040.00 / $2,163.00	Professional	AA	$216.10	$1,040.00	$2,163.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $720.00 / $770.00 / $1,560.00	Professional	QZ	$720.00	$770.00	$1,560.00
Medica Facility/Professional Facility Modifier QK Low / Median / High Price $39.50 / $39.50 / $52.00	Facility	QK	$39.50	$39.50	$52.00
Medica Facility/Professional Facility Modifier QX Low / Median / High Price $39.50 / $39.50 / $52.00	Facility	QX	$39.50	$39.50	$52.00
Medica Facility/Professional Facility Modifier QY Low / Median / High Price $39.50 / $39.50 / $52.00	Facility	QY	$39.50	$39.50	$52.00
United Facility/Professional Professional Modifier AA Low / Median / High Price $88.00 / $654.75 / $903.50	Professional	AA	$88.00	$654.75	$903.50