Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $478.63 / $1,479.11 / $2,187.76	Professional	AA	$478.63	$1,479.11	$2,187.76
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $1,288.25 / $1,288.25 / $1,288.25	Professional	QZ	$1,288.25	$1,288.25	$1,288.25
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $912.01 / $912.01 / $912.01	Professional	AA	$912.01	$912.01	$912.01
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $218.78 / $257.04 / $776.25	Professional	QZ	$218.78	$257.04	$776.25
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 / $1,174.90 / $2,187.76	Professional	AA	$478.63	$1,174.90	$2,187.76
Moda Health Facility/Professional Professional Modifier QZ Low / Median / High Price $1,071.52 / $1,071.52 / $1,288.25	Professional	QZ	$1,071.52	$1,071.52	$1,288.25
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