Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier AA Low / Median / High Price $5,370.32 / $5,370.32 / $11,748.98	Facility	AA	$5,370.32	$5,370.32	$11,748.98
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $691.83 / $1,949.84 / $4,168.69	Professional	AA	$691.83	$1,949.84	$4,168.69
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $758.58 / $977.24 / $2,570.40	Professional	QZ	$758.58	$977.24	$2,570.40
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $1,096.48 / $1,096.48 / $1,096.48	Professional	AA	$1,096.48	$1,096.48	$1,096.48
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 Facility Modifier AA Low / Median / High Price $5,370.32 / $5,370.32 / $11,748.98	Facility	AA	$5,370.32	$5,370.32	$11,748.98
Moda Health Facility/Professional Professional Modifier AA Low / Median / High Price $724.44 / $2,454.71 / $4,265.80	Professional	AA	$724.44	$2,454.71	$4,265.80
Moda Health Facility/Professional Professional Modifier QZ Low / Median / High Price $758.58 / $758.58 / $977.24	Professional	QZ	$758.58	$758.58	$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