Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $434.60 / $980.00 / $1,530.00	Professional	AA	$434.60	$980.00	$1,530.00
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $664.56 / $814.32 / $842.40	Professional	QZ	$664.56	$814.32	$842.40
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $124.38 / $520.00 / $910.00	Professional	AA	$124.38	$520.00	$910.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $140.35 / $195.00 / $1,008.00	Professional	QZ	$140.35	$195.00	$1,008.00
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 $162.80 / $162.80 / $162.80	Facility	QK	$162.80	$162.80	$162.80
Providence Facility/Professional Facility Modifier QX Low / Median / High Price $162.80 / $162.80 / $162.80	Facility	QX	$162.80	$162.80	$162.80
Providence Facility/Professional Facility Modifier QY Low / Median / High Price $162.80 / $162.80 / $162.80	Facility	QY	$162.80	$162.80	$162.80