Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $1,540.00 / $1,540.00 / $1,540.00	Professional	AA	$1,540.00	$1,540.00	$1,540.00
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $875.00 / $875.00 / $875.00	Professional	QZ	$875.00	$875.00	$875.00
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $200.90 / $200.90 / $327.68	Professional	AA	$200.90	$200.90	$327.68
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $140.63 / $200.90 / $595.00	Professional	QZ	$140.63	$200.90	$595.00
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
United Facility/Professional Professional Modifier QZ Low / Median / High Price $75.00 / $75.00 / $75.00	Professional	QZ	$75.00	$75.00	$75.00