Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $703.10 / $1,204.43 / $1,621.02	Professional	AA	$703.10	$1,204.43	$1,621.02
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $1,222.20 / $1,222.20 / $1,222.20	Professional	QZ	$1,222.20	$1,222.20	$1,222.20
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $520.00 / $552.00 / $1,011.75	Professional	AA	$520.00	$552.00	$1,011.75
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $220.55 / $408.00 / $759.00	Professional	QZ	$220.55	$408.00	$759.00
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 $203.50 / $203.50 / $203.50	Facility	QK	$203.50	$203.50	$203.50
Providence Facility/Professional Facility Modifier QX Low / Median / High Price $203.50 / $203.50 / $203.50	Facility	QX	$203.50	$203.50	$203.50
Providence Facility/Professional Facility Modifier QY Low / Median / High Price $203.50 / $203.50 / $203.50	Facility	QY	$203.50	$203.50	$203.50
United Facility/Professional Professional Modifier AA Low / Median / High Price $88.00 / $654.75 / $903.50	Professional	AA	$88.00	$654.75	$903.50