Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $539.50 / $840.00 / $1,400.00	Professional	AA	$539.50	$840.00	$1,400.00
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $277.83 / $277.83 / $277.83	Professional	QZ	$277.83	$277.83	$277.83
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $520.00 / $628.00 / $715.00	Professional	AA	$520.00	$628.00	$715.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $160.40 / $455.00 / $720.00	Professional	QZ	$160.40	$455.00	$720.00
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 $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 $270.00 / $270.00 / $270.00	Professional	QZ	$270.00	$270.00	$270.00