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 / $78.51	Professional	AA	$78.51	$78.51	$78.51
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $250.25 / $250.25 / $250.25	Professional	QX	$250.25	$250.25	$250.25
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $72.23 / $80.20 / $270.89	Professional	QZ	$72.23	$80.20	$270.89
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $100.25 / $140.35 / $650.00	Professional	AA	$100.25	$140.35	$650.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $235.50 / $235.50 / $235.50	Professional	QX	$235.50	$235.50	$235.50
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $260.00 / $325.00 / $325.00	Professional	QZ	$260.00	$325.00	$325.00
Cigna Facility/Professional Professional Modifier QX Low / Median / High Price $120.00 / $120.00 / $120.00	Professional	QX	$120.00	$120.00	$120.00
Cigna Facility/Professional Professional Modifier QY Low / Median / High Price $120.00 / $120.00 / $120.00	Professional	QY	$120.00	$120.00	$120.00
Lucent Health Facility/Professional Facility Modifier QK Low / Median / High Price $37.00 / $39.50 / $52.00	Facility	QK	$37.00	$39.50	$52.00
Lucent Health Facility/Professional Facility Modifier QX Low / Median / High Price $37.00 / $39.50 / $52.00	Facility	QX	$37.00	$39.50	$52.00
Lucent Health Facility/Professional Facility Modifier QY Low / Median / High Price $37.00 / $39.50 / $52.00	Facility	QY	$37.00	$39.50	$52.00
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 / $144.00 / $175.14	Professional	QX	$116.00	$144.00	$175.14
Providence Facility/Professional Professional Modifier QY Low / Median / High Price $116.00 / $144.00 / $175.14	Professional	QY	$116.00	$144.00	$175.14