Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $1,698.24 / $1,698.24 / $1,949.84	Facility	QZ	$1,698.24	$1,698.24	$1,949.84
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $562.34 / $954.99 / $1,819.70	Professional	AA	$562.34	$954.99	$1,819.70
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $331.13 / $602.56 / $891.25	Professional	QX	$331.13	$602.56	$891.25
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $302.00 / $562.34 / $831.76	Professional	QY	$302.00	$562.34	$831.76
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $602.56 / $933.25 / $1,288.25	Professional	QZ	$602.56	$933.25	$1,288.25
Moda Health Facility/Professional Facility Modifier QZ Low / Median / High Price $1,698.24 / $1,698.24 / $1,949.84	Facility	QZ	$1,698.24	$1,698.24	$1,949.84
Moda Health Facility/Professional Professional Modifier AA Low / Median / High Price $691.83 / $1,258.93 / $2,137.96	Professional	AA	$691.83	$1,258.93	$2,137.96
Moda Health Facility/Professional Professional Modifier QX Low / Median / High Price $281.84 / $501.19 / $933.25	Professional	QX	$281.84	$501.19	$933.25
Moda Health Facility/Professional Professional Modifier QY Low / Median / High Price $251.19 / $331.13 / $1,023.29	Professional	QY	$251.19	$331.13	$1,023.29
Moda Health Facility/Professional Professional Modifier QZ Low / Median / High Price $602.56 / $1,096.48 / $3,388.44	Professional	QZ	$602.56	$1,096.48	$3,388.44
Providence Facility/Professional Facility Modifier QK Low / Median / High Price $30.90 / $30.90 / $30.90	Facility	QK	$30.90	$30.90	$30.90
Providence Facility/Professional Facility Modifier QX Low / Median / High Price $30.90 / $30.90 / $30.90	Facility	QX	$30.90	$30.90	$30.90
Providence Facility/Professional Facility Modifier QY Low / Median / High Price $30.90 / $30.90 / $30.90	Facility	QY	$30.90	$30.90	$30.90
Providence Facility/Professional Professional Modifier QX Low / Median / High Price $181.97 / $181.97 / $181.97	Professional	QX	$181.97	$181.97	$181.97
Providence Facility/Professional Professional Modifier QY Low / Median / High Price $181.97 / $181.97 / $181.97	Professional	QY	$181.97	$181.97	$181.97