Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier AA Low / Median / High Price $3,740.00 / $3,740.00 / $4,488.00	Facility	AA	$3,740.00	$3,740.00	$4,488.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $611.04 / $971.70 / $2,380.00	Professional	AA	$611.04	$971.70	$2,380.00
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $283.50 / $332.15 / $527.79	Professional	QX	$283.50	$332.15	$527.79
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $268.45 / $313.95 / $386.75	Professional	QY	$268.45	$313.95	$386.75
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $455.00 / $715.00 / $1,411.00	Professional	AA	$455.00	$715.00	$1,411.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $137.09 / $390.00 / $704.76	Professional	QX	$137.09	$390.00	$704.76
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $260.00 / $325.00 / $325.00	Professional	QY	$260.00	$325.00	$325.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $197.00 / $520.00 / $1,495.00	Professional	QZ	$197.00	$520.00	$1,495.00
Cigna Facility/Professional Professional Modifier QX Low / Median / High Price $180.00 / $180.00 / $180.00	Professional	QX	$180.00	$180.00	$180.00
Cigna Facility/Professional Professional Modifier QY Low / Median / High Price $180.00 / $180.00 / $180.00	Professional	QY	$180.00	$180.00	$180.00
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
Moda Health Facility/Professional Professional Modifier QX Low / Median / High Price $47.00 / $58.00 / $140.00	Professional	QX	$47.00	$58.00	$140.00
Moda Health Facility/Professional Professional Modifier QY Low / Median / High Price $230.71 / $230.71 / $230.71	Professional	QY	$230.71	$230.71	$230.71
Providence Facility/Professional Facility Modifier QK Low / Median / High Price $244.20 / $244.20 / $244.20	Facility	QK	$244.20	$244.20	$244.20
Providence Facility/Professional Facility Modifier QX Low / Median / High Price $244.20 / $244.20 / $244.20	Facility	QX	$244.20	$244.20	$244.20
Providence Facility/Professional Facility Modifier QY Low / Median / High Price $244.20 / $244.20 / $244.20	Facility	QY	$244.20	$244.20	$244.20
Providence Facility/Professional Professional Modifier QX Low / Median / High Price $174.00 / $216.00 / $234.69	Professional	QX	$174.00	$216.00	$234.69
Providence Facility/Professional Professional Modifier QY Low / Median / High Price $174.00 / $216.00 / $234.69	Professional	QY	$174.00	$216.00	$234.69
United Facility/Professional Professional Modifier QY Low / Median / High Price $80.00 / $80.00 / $80.00	Professional	QY	$80.00	$80.00	$80.00