Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $3,360.00 / $3,360.00 / $3,780.00	Professional	AA	$3,360.00	$3,360.00	$3,780.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $969.00 / $2,000.00 / $3,040.00	Professional	QZ	$969.00	$2,000.00	$3,040.00
Lucent Health Facility/Professional Facility Modifier QK Low / Median / High Price $37.00 / $39.50 / $52.00	Facility	QK	$37.00	$39.50	$52.00
Lucent Health Facility/Professional Facility Modifier QX Low / Median / High Price $37.00 / $39.50 / $52.00	Facility	QX	$37.00	$39.50	$52.00
Lucent Health Facility/Professional Facility Modifier QY Low / Median / High Price $37.00 / $39.50 / $52.00	Facility	QY	$37.00	$39.50	$52.00
Providence Facility/Professional Facility Modifier QK Low / Median / High Price $447.70 / $447.70 / $447.70	Facility	QK	$447.70	$447.70	$447.70
Providence Facility/Professional Facility Modifier QX Low / Median / High Price $447.70 / $447.70 / $447.70	Facility	QX	$447.70	$447.70	$447.70
Providence Facility/Professional Facility Modifier QY Low / Median / High Price $447.70 / $447.70 / $447.70	Facility	QY	$447.70	$447.70	$447.70
United Facility/Professional Professional Modifier QZ Low / Median / High Price $80.00 / $80.00 / $80.00	Professional	QZ	$80.00	$80.00	$80.00