Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $812.83 / $1,513.56 / $2,454.71	Professional	AA	$812.83	$1,513.56	$2,454.71
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $588.84 / $724.44 / $2,398.83	Professional	QZ	$588.84	$724.44	$2,398.83
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $194.98 / $1,348.96 / $1,445.44	Professional	AA	$194.98	$1,348.96	$1,445.44
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $338.84 / $954.99 / $1,445.44	Professional	QZ	$338.84	$954.99	$1,445.44
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 $724.44 / $1,258.93 / $2,344.23	Professional	AA	$724.44	$1,258.93	$2,344.23
Moda Health Facility/Professional Professional Modifier QZ Low / Median / High Price $616.60 / $616.60 / $2,041.74	Professional	QZ	$616.60	$616.60	$2,041.74
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