Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier AA Low / Median / High Price $4,466.84 / $4,466.84 / $4,466.84	Facility	AA	$4,466.84	$4,466.84	$4,466.84
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $575.44 / $1,202.26 / $1,698.24	Professional	AA	$575.44	$1,202.26	$1,698.24
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $151.36 / $457.09 / $977.24	Professional	AA	$151.36	$457.09	$977.24
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 $4,466.84 / $4,466.84 / $4,466.84	Facility	AA	$4,466.84	$4,466.84	$4,466.84
Moda Health Facility/Professional Professional Modifier AA Low / Median / High Price $537.03 / $1,000.00 / $1,584.89	Professional	AA	$537.03	$1,000.00	$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