Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier AA Low / Median / High Price $3,740.00 / $3,740.00 / $3,740.00	Facility	AA	$3,740.00	$3,740.00	$3,740.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $485.10 / $738.70 / $1,260.00	Professional	AA	$485.10	$738.70	$1,260.00
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $160.65 / $274.05 / $377.65	Professional	QK	$160.65	$274.05	$377.65
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $220.50 / $280.35 / $391.30	Professional	QX	$220.50	$280.35	$391.30
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $323.05 / $332.15 / $427.70	Professional	QY	$323.05	$332.15	$427.70
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $415.80 / $453.60 / $529.20	Professional	QZ	$415.80	$453.60	$529.20
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $160.40 / $549.50 / $863.50	Professional	AA	$160.40	$549.50	$863.50
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $85.08 / $292.50 / $604.08	Professional	QK	$85.08	$292.50	$604.08
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $60.15 / $260.00 / $487.50	Professional	QX	$60.15	$260.00	$487.50
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $77.00 / $227.50 / $392.50	Professional	QY	$77.00	$227.50	$392.50
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $140.35 / $459.00 / $650.00	Professional	QZ	$140.35	$459.00	$650.00
Cigna Facility/Professional Professional Modifier QK Low / Median / High Price $180.00 / $180.00 / $180.00	Professional	QK	$180.00	$180.00	$180.00
Cigna Facility/Professional Professional Modifier QX Low / Median / High Price $180.00 / $180.00 / $180.00	Professional	QX	$180.00	$180.00	$180.00
Cigna Facility/Professional Professional Modifier QY Low / Median / High Price $180.00 / $180.00 / $180.00	Professional	QY	$180.00	$180.00	$180.00
Lucent Health Facility/Professional Facility Modifier QK Low / Median / High Price $37.00 / $37.00 / $39.50	Facility	QK	$37.00	$37.00	$39.50
Lucent Health Facility/Professional Facility Modifier QX Low / Median / High Price $37.00 / $37.00 / $39.50	Facility	QX	$37.00	$37.00	$39.50
Lucent Health Facility/Professional Facility Modifier QY Low / Median / High Price $37.00 / $37.00 / $39.50	Facility	QY	$37.00	$37.00	$39.50
Moda Health Facility/Professional Professional Modifier QK Low / Median / High Price $23.24 / $116.56 / $240.61	Professional	QK	$23.24	$116.56	$240.61
Moda Health Facility/Professional Professional Modifier QX Low / Median / High Price $100.27 / $180.00 / $280.00	Professional	QX	$100.27	$180.00	$280.00
Moda Health Facility/Professional Professional Modifier QY Low / Median / High Price $76.00 / $232.00 / $277.31	Professional	QY	$76.00	$232.00	$277.31
Providence Facility/Professional Facility Modifier QK Low / Median / High Price $244.20 / $244.20 / $244.20	Facility	QK	$244.20	$244.20	$244.20
Providence Facility/Professional Facility Modifier QX Low / Median / High Price $244.20 / $244.20 / $244.20	Facility	QX	$244.20	$244.20	$244.20
Providence Facility/Professional Facility Modifier QY Low / Median / High Price $244.20 / $244.20 / $244.20	Facility	QY	$244.20	$244.20	$244.20
Providence Facility/Professional Professional Modifier QK Low / Median / High Price $174.00 / $216.00 / $234.69	Professional	QK	$174.00	$216.00	$234.69
Providence Facility/Professional Professional Modifier QX Low / Median / High Price $174.00 / $216.00 / $234.69	Professional	QX	$174.00	$216.00	$234.69
Providence Facility/Professional Professional Modifier QY Low / Median / High Price $174.00 / $216.00 / $234.69	Professional	QY	$174.00	$216.00	$234.69