Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $838.30 / $1,745.70 / $2,940.00	Professional	AA	$838.30	$1,745.70	$2,940.00
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $678.88 / $853.01 / $1,236.54	Professional	QX	$678.88	$853.01	$1,236.54
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $701.53 / $892.69 / $1,120.95	Professional	QY	$701.53	$892.69	$1,120.95
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $585.00 / $975.00 / $2,379.30	Professional	AA	$585.00	$975.00	$2,379.30
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $132.94 / $624.75 / $1,249.50	Professional	QX	$132.94	$624.75	$1,249.50
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $129.02 / $1,249.50 / $1,268.80	Professional	QY	$129.02	$1,249.50	$1,268.80
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $141.75 / $510.00 / $650.00	Professional	QZ	$141.75	$510.00	$650.00
Lucent Health Facility/Professional Facility Modifier QK Low / Median / High Price $37.00 / $37.00 / $39.50	Facility	QK	$37.00	$37.00	$39.50
Lucent Health Facility/Professional Facility Modifier QX Low / Median / High Price $37.00 / $37.00 / $39.50	Facility	QX	$37.00	$37.00	$39.50
Lucent Health Facility/Professional Facility Modifier QY Low / Median / High Price $37.00 / $37.00 / $39.50	Facility	QY	$37.00	$37.00	$39.50
Providence Facility/Professional Facility Modifier QK Low / Median / High Price $244.20 / $244.20 / $244.20	Facility	QK	$244.20	$244.20	$244.20
Providence Facility/Professional Facility Modifier QX Low / Median / High Price $244.20 / $244.20 / $244.20	Facility	QX	$244.20	$244.20	$244.20
Providence Facility/Professional Facility Modifier QY Low / Median / High Price $244.20 / $244.20 / $244.20	Facility	QY	$244.20	$244.20	$244.20
Providence Facility/Professional Professional Modifier QX Low / Median / High Price $174.00 / $217.20 / $247.56	Professional	QX	$174.00	$217.20	$247.56
Providence Facility/Professional Professional Modifier QY Low / Median / High Price $174.00 / $217.20 / $247.56	Professional	QY	$174.00	$217.20	$247.56
United Facility/Professional Professional Modifier QY Low / Median / High Price $80.00 / $80.00 / $80.00	Professional	QY	$80.00	$80.00	$80.00