Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $616.60 / $1,230.27 / $1,659.59	Professional	AA	$616.60	$1,230.27	$1,659.59
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $131.83 / $660.69 / $891.25	Professional	QZ	$131.83	$660.69	$891.25
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $162.18 / $169.82 / $776.25	Professional	AA	$162.18	$169.82	$776.25
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $141.25 / $407.38 / $1,047.13	Professional	QZ	$141.25	$407.38	$1,047.13
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 $616.60 / $1,230.27 / $1,659.59	Professional	AA	$616.60	$1,230.27	$1,659.59
Moda Health Facility/Professional Professional Modifier QZ Low / Median / High Price $131.83 / $223.87 / $812.83	Professional	QZ	$131.83	$223.87	$812.83
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