Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $703.10 / $1,120.00 / $1,540.00	Professional	AA	$703.10	$1,120.00	$1,540.00
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $348.00 / $563.73 / $848.72	Professional	QZ	$348.00	$563.73	$848.72
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $161.19 / $450.00 / $500.00	Professional	AA	$161.19	$450.00	$500.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $155.12 / $221.31 / $450.00	Professional	QZ	$155.12	$221.31	$450.00
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 $273.38 / $410.55 / $527.85	Professional	QZ	$273.38	$410.55	$527.85
United Facility/Professional Professional Modifier AA Low / Median / High Price $88.00 / $88.00 / $88.00	Professional	AA	$88.00	$88.00	$88.00