Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $583.44 / $583.44 / $583.44	Facility	QZ	$583.44	$583.44	$583.44
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $548.79 / $1,163.80 / $1,547.33	Professional	AA	$548.79	$1,163.80	$1,547.33
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $470.63 / $592.04 / $767.05	Professional	QK	$470.63	$592.04	$767.05
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $470.63 / $614.96 / $747.21	Professional	QX	$470.63	$614.96	$747.21
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $437.93 / $623.40 / $747.21	Professional	QY	$437.93	$623.40	$747.21
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $399.17 / $399.17 / $399.17	Professional	QZ	$399.17	$399.17	$399.17
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $267.95 / $612.00 / $936.00	Professional	AA	$267.95	$612.00	$936.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $140.41 / $504.00 / $657.80	Professional	QK	$140.41	$504.00	$657.80
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $132.94 / $357.80 / $658.00	Professional	QX	$132.94	$357.80	$658.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $72.56 / $399.33 / $585.00	Professional	QY	$72.56	$399.33	$585.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $160.88 / $312.00 / $560.00	Professional	QZ	$160.88	$312.00	$560.00
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 QK Low / Median / High Price $174.00 / $217.20 / $247.56	Professional	QK	$174.00	$217.20	$247.56
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