Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $352.89 / $629.09 / $1,400.00	Professional	AA	$352.89	$629.09	$1,400.00
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $318.18 / $592.91 / $785.27	Professional	QZ	$318.18	$592.91	$785.27
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $197.90 / $400.00 / $550.00	Professional	AA	$197.90	$400.00	$550.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $152.54 / $237.72 / $455.00	Professional	QZ	$152.54	$237.72	$455.00
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 $250.60 / $351.90 / $469.20	Professional	QZ	$250.60	$351.90	$469.20
United Facility/Professional Professional Modifier QZ Low / Median / High Price $90.00 / $90.00 / $90.00	Professional	QZ	$90.00	$90.00	$90.00