Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $42.00 / $50.00 / $484.80	Facility		$42.00	$50.00	$484.80
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $805.80 / $996.00 / $2,660.00	Professional	AA	$805.80	$996.00	$2,660.00
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $78.67 / $255.15 / $550.54	Professional	QK	$78.67	$255.15	$550.54
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $242.55 / $343.35 / $700.70	Professional	QX	$242.55	$343.35	$700.70
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $206.32 / $206.32 / $206.32	Professional	QZ	$206.32	$206.32	$206.32
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $334.07 / $785.00 / $1,445.00	Professional	AA	$334.07	$785.00	$1,445.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $100.30 / $353.25 / $667.25	Professional	QK	$100.30	$353.25	$667.25
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $94.91 / $359.13 / $637.50	Professional	QX	$94.91	$359.13	$637.50
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $200.60 / $715.00 / $1,120.00	Professional	QZ	$200.60	$715.00	$1,120.00
BCBS Facility/Professional Facility Modifier Low / Median / High Price $5,456.92 / $5,821.21 / $8,577.84	Facility		$5,456.92	$5,821.21	$8,577.84
Christus Facility/Professional Facility Modifier Low / Median / High Price $20.17 / $91.90 / $91.90	Facility		$20.17	$91.90	$91.90
Cigna Facility/Professional Professional Modifier QK Low / Median / High Price $240.00 / $240.00 / $240.00	Professional	QK	$240.00	$240.00	$240.00
Cigna Facility/Professional Professional Modifier QX Low / Median / High Price $240.00 / $240.00 / $240.00	Professional	QX	$240.00	$240.00	$240.00
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $82.00 / $104.00 / $104.00	Facility		$82.00	$104.00	$104.00
Lucent Health Facility/Professional Facility Modifier QK Low / Median / High Price $37.00 / $39.50 / $52.00	Facility	QK	$37.00	$39.50	$52.00
Lucent Health Facility/Professional Facility Modifier QX Low / Median / High Price $37.00 / $39.50 / $52.00	Facility	QX	$37.00	$39.50	$52.00
Lucent Health Facility/Professional Facility Modifier QY Low / Median / High Price $37.00 / $39.50 / $52.00	Facility	QY	$37.00	$39.50	$52.00
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $105.80 / $3,000.00 / $6,105.00	Facility		$105.80	$3,000.00	$6,105.00
Moda Health Facility/Professional Professional Modifier QK Low / Median / High Price $82.88 / $201.67 / $336.45	Professional	QK	$82.88	$201.67	$336.45
Moda Health Facility/Professional Professional Modifier QX Low / Median / High Price $125.00 / $240.00 / $358.88	Professional	QX	$125.00	$240.00	$358.88
Providence Facility/Professional Facility Modifier Low / Median / High Price $105.80 / $2,500.00 / $6,105.00	Facility		$105.80	$2,500.00	$6,105.00
Providence Facility/Professional Facility Modifier QK Low / Median / High Price $325.60 / $325.60 / $325.60	Facility	QK	$325.60	$325.60	$325.60
Providence Facility/Professional Facility Modifier QX Low / Median / High Price $325.60 / $325.60 / $325.60	Facility	QX	$325.60	$325.60	$325.60
Providence Facility/Professional Facility Modifier QY Low / Median / High Price $325.60 / $325.60 / $325.60	Facility	QY	$325.60	$325.60	$325.60
Providence Facility/Professional Professional Modifier QK Low / Median / High Price $232.00 / $288.00 / $350.28	Professional	QK	$232.00	$288.00	$350.28
Providence Facility/Professional Professional Modifier QX Low / Median / High Price $232.00 / $288.00 / $350.28	Professional	QX	$232.00	$288.00	$350.28