Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $498.00 / $1,124.13 / $1,719.25	Professional	AA	$498.00	$1,124.13	$1,719.25
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $318.18 / $318.18 / $318.18	Professional	QZ	$318.18	$318.18	$318.18
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $476.00 / $674.50 / $1,344.00	Professional	AA	$476.00	$674.50	$1,344.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $160.88 / $464.00 / $539.60	Professional	QZ	$160.88	$464.00	$539.60
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 $80.00 / $480.00 / $1,710.00	Professional	AA	$80.00	$480.00	$1,710.00
United Facility/Professional Professional Modifier QZ Low / Median / High Price $80.00 / $632.45 / $632.45	Professional	QZ	$80.00	$632.45	$632.45