Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $78.51 / $78.51 / $1,163.80	Professional	AA	$78.51	$78.51	$1,163.80
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $65.02 / $65.02 / $65.02	Professional	QX	$65.02	$65.02	$65.02
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $650.00 / $650.00 / $650.00	Professional	AA	$650.00	$650.00	$650.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $100.55 / $100.55 / $100.55	Professional	QZ	$100.55	$100.55	$100.55
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 $162.80 / $162.80 / $162.80	Facility	QK	$162.80	$162.80	$162.80
Providence Facility/Professional Facility Modifier QX Low / Median / High Price $162.80 / $162.80 / $162.80	Facility	QX	$162.80	$162.80	$162.80
Providence Facility/Professional Facility Modifier QY Low / Median / High Price $162.80 / $162.80 / $162.80	Facility	QY	$162.80	$162.80	$162.80
Providence Facility/Professional Professional Modifier QX Low / Median / High Price $116.00 / $144.80 / $175.14	Professional	QX	$116.00	$144.80	$175.14
Providence Facility/Professional Professional Modifier QY Low / Median / High Price $116.00 / $144.80 / $175.14	Professional	QY	$116.00	$144.80	$175.14