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 $108.07 / $410.80 / $700.00	Professional	AA	$108.07	$410.80	$700.00
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $85.17 / $124.38 / $845.00	Professional	AA	$85.17	$124.38	$845.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $336.00 / $336.00 / $336.00	Professional	QY	$336.00	$336.00	$336.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $455.00 / $455.00 / $455.00	Professional	QZ	$455.00	$455.00	$455.00
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 / $181.00 / $203.50	Professional	QX	$145.00	$181.00	$203.50
Providence Facility/Professional Professional Modifier QY Low / Median / High Price $145.00 / $181.00 / $203.50	Professional	QY	$145.00	$181.00	$203.50