Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $1,318.26 / $3,388.44 / $4,677.35	Professional	AA	$1,318.26	$3,388.44	$4,677.35
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $676.08 / $1,122.02 / $1,122.02	Professional	QZ	$676.08	$1,122.02	$1,122.02
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $426.58 / $426.58 / $1,096.48	Professional	AA	$426.58	$426.58	$1,096.48
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $977.24 / $1,174.90 / $2,691.53	Professional	QZ	$977.24	$1,174.90	$2,691.53
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 $870.96 / $3,388.44 / $4,897.79	Professional	AA	$870.96	$3,388.44	$4,897.79
Moda Health Facility/Professional Professional Modifier QZ Low / Median / High Price $676.08 / $676.08 / $1,122.02	Professional	QZ	$676.08	$676.08	$1,122.02
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