Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier AA Low / Median / High Price $9,549.93 / $9,549.93 / $9,549.93	Facility	AA	$9,549.93	$9,549.93	$9,549.93
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 $9,549.93 / $9,549.93 / $9,549.93	Facility	AA	$9,549.93	$9,549.93	$9,549.93
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