Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $805.10 / $806.60 / $1,707.72	Professional	AA	$805.10	$806.60	$1,707.72
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $287.50 / $715.00 / $1,711.56	Professional	AA	$287.50	$715.00	$1,711.56
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $357.50 / $357.50 / $357.50	Professional	QX	$357.50	$357.50	$357.50
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $105.45 / $105.45 / $140.35	Professional	QY	$105.45	$105.45	$140.35
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $198.00 / $408.00 / $1,200.00	Professional	QZ	$198.00	$408.00	$1,200.00
Cigna Facility/Professional Professional Modifier QX Low / Median / High Price $180.00 / $180.00 / $180.00	Professional	QX	$180.00	$180.00	$180.00
Cigna Facility/Professional Professional Modifier QY Low / Median / High Price $180.00 / $180.00 / $180.00	Professional	QY	$180.00	$180.00	$180.00
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 $244.20 / $244.20 / $244.20	Facility	QK	$244.20	$244.20	$244.20
Providence Facility/Professional Facility Modifier QX Low / Median / High Price $244.20 / $244.20 / $244.20	Facility	QX	$244.20	$244.20	$244.20
Providence Facility/Professional Facility Modifier QY Low / Median / High Price $244.20 / $244.20 / $244.20	Facility	QY	$244.20	$244.20	$244.20
Providence Facility/Professional Professional Modifier QX Low / Median / High Price $180.00 / $216.00 / $262.70	Professional	QX	$180.00	$216.00	$262.70
Providence Facility/Professional Professional Modifier QY Low / Median / High Price $180.00 / $216.00 / $262.70	Professional	QY	$180.00	$216.00	$262.70