Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier AA Low / Median / High Price $3,715.35 / $4,466.84 / $5,128.61	Facility	AA	$3,715.35	$4,466.84	$5,128.61
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $758.58 / $1,548.82 / $2,754.23	Professional	AA	$758.58	$1,548.82	$2,754.23
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $363.08 / $616.60 / $977.24	Professional	QX	$363.08	$616.60	$977.24
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $309.03 / $562.34 / $977.24	Professional	QY	$309.03	$562.34	$977.24
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $524.81 / $707.95 / $2,238.72	Professional	QZ	$524.81	$707.95	$2,238.72
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $302.00 / $645.65 / $1,202.26	Professional	AA	$302.00	$645.65	$1,202.26
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $125.89 / $354.81 / $660.69	Professional	QX	$125.89	$354.81	$660.69
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $229.09 / $257.04 / $676.08	Professional	QY	$229.09	$257.04	$676.08
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $181.97 / $524.81 / $741.31	Professional	QZ	$181.97	$524.81	$741.31
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 $3,715.35 / $4,466.84 / $5,128.61	Facility	AA	$3,715.35	$4,466.84	$5,128.61
Moda Health Facility/Professional Professional Modifier AA Low / Median / High Price $588.84 / $1,318.26 / $2,630.27	Professional	AA	$588.84	$1,318.26	$2,630.27
Moda Health Facility/Professional Professional Modifier QX Low / Median / High Price $323.59 / $575.44 / $1,096.48	Professional	QX	$323.59	$575.44	$1,096.48
Moda Health Facility/Professional Professional Modifier QY Low / Median / High Price $275.42 / $467.74 / $1,047.13	Professional	QY	$275.42	$467.74	$1,047.13
Moda Health Facility/Professional Professional Modifier QZ Low / Median / High Price $478.63 / $1,096.48 / $2,238.72	Professional	QZ	$478.63	$1,096.48	$2,238.72
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