Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $645.65 / $1,096.48 / $1,698.24	Professional	AA	$645.65	$1,096.48	$1,698.24
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $389.05 / $758.58 / $1,698.24	Professional	QZ	$389.05	$758.58	$1,698.24
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $467.74 / $776.25 / $1,023.29	Professional	AA	$467.74	$776.25	$1,023.29
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $162.18 / $512.86 / $954.99	Professional	QZ	$162.18	$512.86	$954.99
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 $512.86 / $1,047.13 / $1,584.89	Professional	AA	$512.86	$1,047.13	$1,584.89
Moda Health Facility/Professional Professional Modifier QZ Low / Median / High Price $389.05 / $537.03 / $851.14	Professional	QZ	$389.05	$537.03	$851.14
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