Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $722.00 / $722.00 / $950.00	Facility	QZ	$722.00	$722.00	$950.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $403.00 / $840.00 / $1,400.00	Professional	AA	$403.00	$840.00	$1,400.00
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $578.54 / $655.20 / $786.24	Professional	QZ	$578.54	$655.20	$786.24
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 QZ Low / Median / High Price $632.45 / $632.45 / $632.45	Professional	QZ	$632.45	$632.45	$632.45