Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier AA Low / Median / High Price $8,317.64 / $8,317.64 / $9,549.93	Facility	AA	$8,317.64	$8,317.64	$9,549.93
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $616.60 / $1,230.27 / $2,041.74	Professional	AA	$616.60	$1,230.27	$2,041.74
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $204.17 / $691.83 / $1,698.24	Professional	QZ	$204.17	$691.83	$1,698.24
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $181.97 / $707.95 / $1,288.25	Professional	AA	$181.97	$707.95	$1,288.25
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $218.78 / $588.84 / $1,122.02	Professional	QZ	$218.78	$588.84	$1,122.02
Lucent Health Facility/Professional Facility Modifier QK Low / Median / High Price $52.48 / $52.48 / $52.48	Facility	QK	$52.48	$52.48	$52.48
Lucent Health Facility/Professional Facility Modifier QX Low / Median / High Price $52.48 / $52.48 / $52.48	Facility	QX	$52.48	$52.48	$52.48
Lucent Health Facility/Professional Facility Modifier QY Low / Median / High Price $52.48 / $52.48 / $52.48	Facility	QY	$52.48	$52.48	$52.48
Moda Health Facility/Professional Facility Modifier AA Low / Median / High Price $8,317.64 / $8,317.64 / $9,549.93	Facility	AA	$8,317.64	$8,317.64	$9,549.93
Moda Health Facility/Professional Professional Modifier AA Low / Median / High Price $575.44 / $1,096.48 / $1,949.84	Professional	AA	$575.44	$1,096.48	$1,949.84
Moda Health Facility/Professional Professional Modifier QZ Low / Median / High Price $204.17 / $660.69 / $1,698.24	Professional	QZ	$204.17	$660.69	$1,698.24
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