Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.00 / $41.00 / $955.00	Facility		$38.00	$41.00	$955.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $146.21 / $529.29 / $529.29	Professional	AA	$146.21	$529.29	$529.29
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $103.65 / $103.65 / $1,105.00	Professional	AA	$103.65	$103.65	$1,105.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $291.55 / $291.55 / $291.55	Professional	QX	$291.55	$291.55	$291.55
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $182.25 / $182.25 / $390.00	Professional	QZ	$182.25	$182.25	$390.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $154.05 / $250.00 / $430.00	Professional		$154.05	$250.00	$430.00
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $82.00 / $82.00 / $82.00	Facility		$82.00	$82.00	$82.00
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 Low / Median / High Price $407.00 / $3,375.00 / $4,100.00	Facility		$407.00	$3,375.00	$4,100.00
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
Providence Facility/Professional Professional Modifier QX Low / Median / High Price $145.00 / $180.00 / $206.30	Professional	QX	$145.00	$180.00	$206.30
Providence Facility/Professional Professional Modifier QY Low / Median / High Price $145.00 / $180.00 / $206.30	Professional	QY	$145.00	$180.00	$206.30