Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier AA Low / Median / High Price $5,370.32 / $5,370.32 / $6,309.57	Facility	AA	$5,370.32	$5,370.32	$6,309.57
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $562.34 / $1,023.29 / $1,778.28	Professional	AA	$562.34	$1,023.29	$1,778.28
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $346.74 / $616.60 / $1,288.25	Professional	QZ	$346.74	$616.60	$1,288.25
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $181.97 / $512.86 / $1,023.29	Professional	AA	$181.97	$512.86	$1,023.29
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $158.49 / $302.00 / $794.33	Professional	QZ	$158.49	$302.00	$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 Facility Modifier AA Low / Median / High Price $5,370.32 / $5,370.32 / $6,309.57	Facility	AA	$5,370.32	$5,370.32	$6,309.57
Moda Health Facility/Professional Professional Modifier AA Low / Median / High Price $501.19 / $954.99 / $1,698.24	Professional	AA	$501.19	$954.99	$1,698.24
Moda Health Facility/Professional Professional Modifier QZ Low / Median / High Price $346.74 / $575.44 / $1,258.93	Professional	QZ	$346.74	$575.44	$1,258.93
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