Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $1,961.60 / $1,961.60 / $1,961.60	Facility	QZ	$1,961.60	$1,961.60	$1,961.60
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $500.66 / $1,294.38 / $2,660.00	Professional	AA	$500.66	$1,294.38	$2,660.00
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 $171.00 / $183.00 / $243.00	Professional	QX	$171.00	$183.00	$243.00
Providence Facility/Professional Professional Modifier QY Low / Median / High Price $171.00 / $183.00 / $243.00	Professional	QY	$171.00	$183.00	$243.00
United Facility/Professional Professional Modifier QY Low / Median / High Price $80.00 / $80.00 / $80.00	Professional	QY	$80.00	$80.00	$80.00