Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $2,152.19 / $2,152.19 / $2,152.19	Facility	QZ	$2,152.19	$2,152.19	$2,152.19
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $462.80 / $1,120.00 / $1,820.00	Professional	AA	$462.80	$1,120.00	$1,820.00
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $516.20 / $645.42 / $753.54	Professional	QZ	$516.20	$645.42	$753.54
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $168.76 / $350.00 / $450.00	Professional	AA	$168.76	$350.00	$450.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $162.21 / $190.18 / $510.00	Professional	QZ	$162.21	$190.18	$510.00
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 $351.90 / $527.85 / $586.50	Professional	QZ	$351.90	$527.85	$586.50