Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $107.15 / $812.83 / $1,096.48	Professional	AA	$107.15	$812.83	$1,096.48
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $1,047.13 / $1,122.02 / $1,174.90	Professional	QZ	$1,047.13	$1,122.02	$1,174.90
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $138.04 / $389.05 / $676.08	Professional	AA	$138.04	$389.05	$676.08
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $208.93 / $208.93 / $501.19	Professional	QZ	$208.93	$208.93	$501.19
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 Professional Modifier AA Low / Median / High Price $112.20 / $660.69 / $1,047.13	Professional	AA	$112.20	$660.69	$1,047.13
Moda Health Facility/Professional Professional Modifier QZ Low / Median / High Price $91.20 / $102.33 / $537.03	Professional	QZ	$91.20	$102.33	$537.03
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