Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier AA Low / Median / High Price $10,000.00 / $10,000.00 / $10,000.00	Facility	AA	$10,000.00	$10,000.00	$10,000.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $588.84 / $1,096.48 / $1,548.82	Professional	AA	$588.84	$1,096.48	$1,548.82
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $346.74 / $602.56 / $1,258.93	Professional	QZ	$346.74	$602.56	$1,258.93
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $158.49 / $524.81 / $1,202.26	Professional	AA	$158.49	$524.81	$1,202.26
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $162.18 / $457.09 / $794.33	Professional	QZ	$162.18	$457.09	$794.33
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 $10,000.00 / $10,000.00 / $10,000.00	Facility	AA	$10,000.00	$10,000.00	$10,000.00
Moda Health Facility/Professional Professional Modifier AA Low / Median / High Price $588.84 / $1,000.00 / $1,548.82	Professional	AA	$588.84	$1,000.00	$1,548.82
Moda Health Facility/Professional Professional Modifier QZ Low / Median / High Price $346.74 / $575.44 / $1,000.00	Professional	QZ	$346.74	$575.44	$1,000.00
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