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 / $722.00	Facility	QZ	$722.00	$722.00	$722.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $565.77 / $991.80 / $2,100.00	Professional	AA	$565.77	$991.80	$2,100.00
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $758.16 / $758.16 / $758.16	Professional	QZ	$758.16	$758.16	$758.16
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