Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $616.60 / $1,071.52 / $1,584.89	Professional	AA	$616.60	$1,071.52	$1,584.89
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $295.12 / $295.12 / $295.12	Professional	QZ	$295.12	$295.12	$295.12
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $645.65 / $645.65 / $707.95	Professional	AA	$645.65	$645.65	$707.95
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 $588.84 / $1,071.52 / $1,584.89	Professional	AA	$588.84	$1,071.52	$1,584.89
Moda Health Facility/Professional Professional Modifier QZ Low / Median / High Price $295.12 / $295.12 / $295.12	Professional	QZ	$295.12	$295.12	$295.12
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