Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier AA Low / Median / High Price $6,918.31 / $6,918.31 / $6,918.31	Facility	AA	$6,918.31	$6,918.31	$6,918.31
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $630.96 / $1,479.11 / $2,884.03	Professional	AA	$630.96	$1,479.11	$2,884.03
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $363.08 / $741.31 / $1,698.24	Professional	QZ	$363.08	$741.31	$1,698.24
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $204.17 / $524.81 / $870.96	Professional	AA	$204.17	$524.81	$870.96
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $141.25 / $354.81 / $794.33	Professional	QZ	$141.25	$354.81	$794.33
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 $6,918.31 / $6,918.31 / $6,918.31	Facility	AA	$6,918.31	$6,918.31	$6,918.31
Moda Health Facility/Professional Professional Modifier AA Low / Median / High Price $549.54 / $1,412.54 / $2,951.21	Professional	AA	$549.54	$1,412.54	$2,951.21
Moda Health Facility/Professional Professional Modifier QZ Low / Median / High Price $338.84 / $630.96 / $1,584.89	Professional	QZ	$338.84	$630.96	$1,584.89
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