Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $247.75 / $247.75 / $247.75	Professional	QX	$247.75	$247.75	$247.75
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $99.07 / $327.60 / $472.50	Professional	QZ	$99.07	$327.60	$472.50
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $100.25 / $455.00 / $520.00	Professional	AA	$100.25	$455.00	$520.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $60.15 / $63.27 / $195.00	Professional	QX	$60.15	$63.27	$195.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $60.15 / $60.15 / $227.50	Professional	QY	$60.15	$60.15	$227.50
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $120.30 / $306.00 / $420.00	Professional	QZ	$120.30	$306.00	$420.00
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
Moda Health Facility/Professional Professional Modifier QX Low / Median / High Price $126.00 / $126.00 / $126.00	Professional	QX	$126.00	$126.00	$126.00
Moda Health Facility/Professional Professional Modifier QY Low / Median / High Price $30.33 / $30.33 / $30.33	Professional	QY	$30.33	$30.33	$30.33
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 $150.00 / $180.00 / $218.93	Professional	QX	$150.00	$180.00	$218.93
Providence Facility/Professional Professional Modifier QY Low / Median / High Price $150.00 / $180.00 / $218.93	Professional	QY	$150.00	$180.00	$218.93