Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $489.78 / $954.99 / $1,548.82	Professional	AA	$489.78	$954.99	$1,548.82
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $316.23 / $549.54 / $1,230.27	Professional	QZ	$316.23	$549.54	$1,230.27
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $154.88 / $524.81 / $851.14	Professional	AA	$154.88	$524.81	$851.14
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $134.90 / $218.78 / $588.84	Professional	QZ	$134.90	$218.78	$588.84
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 $478.63 / $891.25 / $1,513.56	Professional	AA	$478.63	$891.25	$1,513.56
Moda Health Facility/Professional Professional Modifier QZ Low / Median / High Price $281.84 / $575.44 / $977.24	Professional	QZ	$281.84	$575.44	$977.24
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