Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $309.03 / $1,621.81 / $2,570.40	Professional	AA	$309.03	$1,621.81	$2,570.40
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $117.49 / $128.82 / $1,096.48	Professional	QZ	$117.49	$128.82	$1,096.48
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $457.09 / $776.25 / $933.25	Professional	AA	$457.09	$776.25	$933.25
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $141.25 / $457.09 / $812.83	Professional	QZ	$141.25	$457.09	$812.83
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 $309.03 / $1,584.89 / $2,570.40	Professional	AA	$309.03	$1,584.89	$2,570.40
Moda Health Facility/Professional Professional Modifier QZ Low / Median / High Price $117.49 / $128.82 / $1,096.48	Professional	QZ	$117.49	$128.82	$1,096.48
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