Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $457.09 / $977.24 / $1,698.24	Professional	AA	$457.09	$977.24	$1,698.24
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $295.12 / $501.19 / $1,230.27	Professional	QZ	$295.12	$501.19	$1,230.27
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $141.25 / $457.09 / $870.96	Professional	AA	$141.25	$457.09	$870.96
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $138.04 / $354.81 / $660.69	Professional	QZ	$138.04	$354.81	$660.69
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 $436.52 / $891.25 / $1,659.59	Professional	AA	$436.52	$891.25	$1,659.59
Moda Health Facility/Professional Professional Modifier QZ Low / Median / High Price $295.12 / $537.03 / $977.24	Professional	QZ	$295.12	$537.03	$977.24
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