Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier AA Low / Median / High Price $3,715.35 / $3,715.35 / $3,715.35	Facility	AA	$3,715.35	$3,715.35	$3,715.35
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $501.19 / $1,000.00 / $1,445.44	Professional	AA	$501.19	$1,000.00	$1,445.44
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $263.03 / $398.11 / $645.65	Professional	QK	$263.03	$398.11	$645.65
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $251.19 / $398.11 / $645.65	Professional	QX	$251.19	$398.11	$645.65
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $281.84 / $407.38 / $741.31	Professional	QY	$281.84	$407.38	$741.31
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $389.05 / $602.56 / $912.01	Professional	QZ	$389.05	$602.56	$912.01
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $154.88 / $467.74 / $645.65	Professional	AA	$154.88	$467.74	$645.65
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $81.28 / $125.89 / $323.59	Professional	QK	$81.28	$125.89	$323.59
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $81.28 / $147.91 / $354.81	Professional	QX	$81.28	$147.91	$354.81
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $85.11 / $295.12 / $354.81	Professional	QY	$85.11	$295.12	$354.81
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $141.25 / $181.97 / $588.84	Professional	QZ	$141.25	$181.97	$588.84
Lucent Health Facility/Professional Facility Modifier QK Low / Median / High Price $134.90 / $134.90 / $134.90	Facility	QK	$134.90	$134.90	$134.90
Lucent Health Facility/Professional Facility Modifier QX Low / Median / High Price $134.90 / $134.90 / $134.90	Facility	QX	$134.90	$134.90	$134.90
Lucent Health Facility/Professional Facility Modifier QY Low / Median / High Price $134.90 / $134.90 / $134.90	Facility	QY	$134.90	$134.90	$134.90
Moda Health Facility/Professional Facility Modifier AA Low / Median / High Price $3,715.35 / $3,715.35 / $3,715.35	Facility	AA	$3,715.35	$3,715.35	$3,715.35
Moda Health Facility/Professional Professional Modifier AA Low / Median / High Price $489.78 / $912.01 / $1,412.54	Professional	AA	$489.78	$912.01	$1,412.54
Moda Health Facility/Professional Professional Modifier QK Low / Median / High Price $234.42 / $389.05 / $707.95	Professional	QK	$234.42	$389.05	$707.95
Moda Health Facility/Professional Professional Modifier QX Low / Median / High Price $229.09 / $398.11 / $691.83	Professional	QX	$229.09	$398.11	$691.83
Moda Health Facility/Professional Professional Modifier QY Low / Median / High Price $223.87 / $436.52 / $741.31	Professional	QY	$223.87	$436.52	$741.31
Moda Health Facility/Professional Professional Modifier QZ Low / Median / High Price $380.19 / $562.34 / $851.14	Professional	QZ	$380.19	$562.34	$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