Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $125.90 / $390.60 / $396.90	Professional	QZ	$125.90	$390.60	$396.90
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $140.35 / $140.35 / $520.00	Professional	AA	$140.35	$140.35	$520.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $50.13 / $227.50 / $260.00	Professional	QX	$50.13	$227.50	$260.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $50.13 / $50.13 / $260.00	Professional	QY	$50.13	$50.13	$260.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $120.30 / $306.00 / $390.00	Professional	QZ	$120.30	$306.00	$390.00
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 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 / $196.50	Professional	QX	$145.00	$180.00	$196.50
Providence Facility/Professional Professional Modifier QY Low / Median / High Price $145.00 / $180.00 / $196.50	Professional	QY	$145.00	$180.00	$196.50