Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $537.03 / $870.96 / $1,698.24	Professional	AA	$537.03	$870.96	$1,698.24
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $537.03 / $741.31 / $1,148.15	Professional	QZ	$537.03	$741.31	$1,148.15
Moda Health Facility/Professional Professional Modifier AA Low / Median / High Price $537.03 / $1,000.00 / $1,862.09	Professional	AA	$537.03	$1,000.00	$1,862.09
Moda Health Facility/Professional Professional Modifier QZ Low / Median / High Price $549.54 / $1,148.15 / $1,995.26	Professional	QZ	$549.54	$1,148.15	$1,995.26
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