Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $234.42 / $489.78 / $1,348.96	Professional	AA	$234.42	$489.78	$1,348.96
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $269.15 / $380.19 / $537.03	Professional	QX	$269.15	$380.19	$537.03
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $269.15 / $316.23 / $389.05	Professional	QY	$269.15	$316.23	$389.05
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $72.44 / $269.15 / $602.56	Professional	QZ	$72.44	$269.15	$602.56
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $125.89 / $125.89 / $125.89	Professional	AA	$125.89	$125.89	$125.89
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $50.12 / $50.12 / $50.12	Professional	QX	$50.12	$50.12	$50.12
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $257.04 / $269.15 / $309.03	Professional	QZ	$257.04	$269.15	$309.03
Medica Facility/Professional Facility Modifier QK Low / Median / High Price $39.81 / $39.81 / $39.81	Facility	QK	$39.81	$39.81	$39.81
Medica Facility/Professional Facility Modifier QX Low / Median / High Price $39.81 / $39.81 / $39.81	Facility	QX	$39.81	$39.81	$39.81
Medica Facility/Professional Facility Modifier QY Low / Median / High Price $39.81 / $39.81 / $39.81	Facility	QY	$39.81	$39.81	$39.81
Qualchoice Facility/Professional Professional Modifier QZ Low / Median / High Price $295.12 / $295.12 / $354.81	Professional	QZ	$295.12	$295.12	$354.81