Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $489.78 / $1,288.25 / $1,949.84	Professional	AA	$489.78	$1,288.25	$1,949.84
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $309.03 / $457.09 / $1,737.80	Professional	QZ	$309.03	$457.09	$1,737.80
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $457.09 / $457.09 / $870.96	Professional	AA	$457.09	$457.09	$870.96
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $147.91 / $223.87 / $794.33	Professional	QZ	$147.91	$223.87	$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 Professional Modifier AA Low / Median / High Price $489.78 / $1,258.93 / $1,819.70	Professional	AA	$489.78	$1,258.93	$1,819.70
Moda Health Facility/Professional Professional Modifier QZ Low / Median / High Price $218.78 / $309.03 / $1,737.80	Professional	QZ	$218.78	$309.03	$1,737.80
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