Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $41.69 / $50.12 / $302.00	Facility		$41.69	$50.12	$302.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $524.81 / $724.44 / $1,659.59	Professional	AA	$524.81	$724.44	$1,659.59
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $524.81 / $691.83 / $912.01	Professional	QX	$524.81	$691.83	$912.01
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $95.50 / $331.13 / $501.19	Professional	QZ	$95.50	$331.13	$501.19
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $100.00 / $100.00 / $389.05	Professional	AA	$100.00	$100.00	$389.05
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $63.10 / $63.10 / $194.98	Professional	QX	$63.10	$63.10	$194.98
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $123.03 / $309.03 / $389.05	Professional	QZ	$123.03	$309.03	$389.05
BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,162.28 / $3,548.13 / $4,265.80	Facility		$3,162.28	$3,548.13	$4,265.80
Christus Facility/Professional Facility Modifier Low / Median / High Price $21.38 / $138.04 / $138.04	Facility		$21.38	$138.04	$138.04
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $104.71 / $104.71	Facility		$104.71	$104.71	$104.71
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 Low / Median / High Price $45.71 / $2,344.23 / $6,165.95	Facility		$45.71	$2,344.23	$6,165.95
Moda Health Facility/Professional Professional Modifier AA Low / Median / High Price $524.81 / $1,288.25 / $1,659.59	Professional	AA	$524.81	$1,288.25	$1,659.59
Moda Health Facility/Professional Professional Modifier QX Low / Median / High Price $691.83 / $691.83 / $691.83	Professional	QX	$691.83	$691.83	$691.83
Moda Health Facility/Professional Professional Modifier QZ Low / Median / High Price $95.50 / $331.13 / $363.08	Professional	QZ	$95.50	$331.13	$363.08
Providence Facility/Professional Facility Modifier Low / Median / High Price $41.69 / $2,570.40 / $5,888.44	Facility		$41.69	$2,570.40	$5,888.44
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