Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $907.20 / $1,540.00 / $2,240.00	Professional	AA	$907.20	$1,540.00	$2,240.00
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $874.19 / $955.89 / $1,166.00	Professional	QZ	$874.19	$955.89	$1,166.00
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $178.11 / $650.00 / $650.00	Professional	AA	$178.11	$650.00	$650.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $193.90 / $254.90 / $510.00	Professional	QZ	$193.90	$254.90	$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 $586.50 / $586.50 / $586.50	Professional	QZ	$586.50	$586.50	$586.50
United Facility/Professional Professional Modifier QZ Low / Median / High Price $85.00 / $85.00 / $85.00	Professional	QZ	$85.00	$85.00	$85.00