Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.02 / $346.74 / $1,000.00	Facility		$38.02	$346.74	$1,000.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $446.68 / $524.81 / $524.81	Professional	AA	$446.68	$524.81	$524.81
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $524.81 / $691.83 / $912.01	Professional	QX	$524.81	$691.83	$912.01
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $95.50 / $331.13 / $501.19	Professional	QZ	$95.50	$331.13	$501.19
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $323.59 / $323.59 / $389.05	Professional	QZ	$323.59	$323.59	$389.05
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $229.09 / $416.87	Professional		$112.20	$229.09	$416.87
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $104.71 / $104.71	Facility		$104.71	$104.71	$104.71
Lucent Health Facility/Professional Facility Modifier QK Low / Median / High Price $52.48 / $52.48 / $52.48	Facility	QK	$52.48	$52.48	$52.48
Lucent Health Facility/Professional Facility Modifier QX Low / Median / High Price $52.48 / $52.48 / $52.48	Facility	QX	$52.48	$52.48	$52.48
Lucent Health Facility/Professional Facility Modifier QY Low / Median / High Price $52.48 / $52.48 / $52.48	Facility	QY	$52.48	$52.48	$52.48
Providence Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $3,630.78 / $5,623.41	Facility		$87.10	$3,630.78	$5,623.41
Providence Facility/Professional Professional Modifier QX Low / Median / High Price $151.36 / $151.36 / $151.36	Professional	QX	$151.36	$151.36	$151.36
Providence Facility/Professional Professional Modifier QY Low / Median / High Price $151.36 / $151.36 / $151.36	Professional	QY	$151.36	$151.36	$151.36