Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $42.00 / $50.00 / $303.00	Facility		$42.00	$50.00	$303.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $119.71 / $410.80 / $413.10	Professional	AA	$119.71	$410.80	$413.10
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $229.73 / $229.73 / $238.74	Professional	QX	$229.73	$229.73	$238.74
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $92.78 / $283.50 / $384.30	Professional	QZ	$92.78	$283.50	$384.30
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $100.25 / $325.00 / $845.00	Professional	AA	$100.25	$325.00	$845.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $50.13 / $195.00 / $196.25	Professional	QX	$50.13	$195.00	$196.25
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $50.13 / $196.25 / $235.50	Professional	QY	$50.13	$196.25	$235.50
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $100.25 / $325.00 / $455.00	Professional	QZ	$100.25	$325.00	$455.00
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 / $136.80 / $136.80	Facility		$20.17	$136.80	$136.80
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $82.00 / $82.00 / $82.00	Facility		$82.00	$82.00	$82.00
Lucent Health Facility/Professional Facility Modifier QK Low / Median / High Price $37.00 / $37.00 / $39.50	Facility	QK	$37.00	$37.00	$39.50
Lucent Health Facility/Professional Facility Modifier QX Low / Median / High Price $37.00 / $37.00 / $39.50	Facility	QX	$37.00	$37.00	$39.50
Lucent Health Facility/Professional Facility Modifier QY Low / Median / High Price $37.00 / $37.00 / $39.50	Facility	QY	$37.00	$37.00	$39.50
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
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 $203.50 / $203.50 / $203.50	Facility	QK	$203.50	$203.50	$203.50
Providence Facility/Professional Facility Modifier QX Low / Median / High Price $203.50 / $203.50 / $203.50	Facility	QX	$203.50	$203.50	$203.50
Providence Facility/Professional Facility Modifier QY Low / Median / High Price $203.50 / $203.50 / $203.50	Facility	QY	$203.50	$203.50	$203.50
Providence Facility/Professional Professional Modifier QX Low / Median / High Price $150.00 / $180.00 / $218.93	Professional	QX	$150.00	$180.00	$218.93
Providence Facility/Professional Professional Modifier QY Low / Median / High Price $150.00 / $180.00 / $218.93	Professional	QY	$150.00	$180.00	$218.93