Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $234.42 / $602.56 / $1,174.90	Professional	AA	$234.42	$602.56	$1,174.90
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $245.47 / $363.08 / $537.03	Professional	QX	$245.47	$363.08	$537.03
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $269.15 / $389.05 / $446.68	Professional	QY	$269.15	$389.05	$446.68
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $72.44 / $100.00 / $269.15	Professional	QZ	$72.44	$100.00	$269.15
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $79.43 / $79.43 / $79.43	Professional	AA	$79.43	$79.43	$79.43
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $50.12 / $50.12 / $194.98	Professional	QX	$50.12	$50.12	$194.98
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $97.72 / $257.04 / $323.59	Professional	QZ	$97.72	$257.04	$323.59
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 $234.42 / $724.44 / $1,174.90	Professional	AA	$234.42	$724.44	$1,174.90
Moda Health Facility/Professional Professional Modifier QX Low / Median / High Price $199.53 / $269.15 / $446.68	Professional	QX	$199.53	$269.15	$446.68
Moda Health Facility/Professional Professional Modifier QY Low / Median / High Price $281.84 / $398.11 / $446.68	Professional	QY	$281.84	$398.11	$446.68
Moda Health Facility/Professional Professional Modifier QZ Low / Median / High Price $72.44 / $100.00 / $269.15	Professional	QZ	$72.44	$100.00	$269.15
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