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 Facility Modifier AA Low / Median / High Price $537.03 / $537.03 / $537.03	Facility	AA	$537.03	$537.03	$537.03
Aetna Facility/Professional Facility Modifier QK Low / Median / High Price $275.42 / $275.42 / $275.42	Facility	QK	$275.42	$275.42	$275.42
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $380.19 / $812.83 / $1,202.26	Professional	AA	$380.19	$812.83	$1,202.26
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $208.93 / $323.59 / $588.84	Professional	QK	$208.93	$323.59	$588.84
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $213.80 / $338.84 / $588.84	Professional	QX	$213.80	$338.84	$588.84
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $223.87 / $302.00 / $562.34	Professional	QY	$223.87	$302.00	$562.34
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $245.47 / $512.86 / $758.58	Professional	QZ	$245.47	$512.86	$758.58
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $120.23 / $389.05 / $707.95	Professional	AA	$120.23	$389.05	$707.95
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $67.61 / $112.20 / $316.23	Professional	QK	$67.61	$112.20	$316.23
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $67.61 / $154.88 / $316.23	Professional	QX	$67.61	$154.88	$316.23
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $74.13 / $229.09 / $338.84	Professional	QY	$74.13	$229.09	$338.84
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $120.23 / $154.88 / $457.09	Professional	QZ	$120.23	$154.88	$457.09
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 $39.81 / $79.43 / $79.43	Facility		$39.81	$79.43	$79.43
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 Facility Modifier AA Low / Median / High Price $537.03 / $537.03 / $537.03	Facility	AA	$537.03	$537.03	$537.03
Moda Health Facility/Professional Facility Modifier QK Low / Median / High Price $275.42 / $275.42 / $275.42	Facility	QK	$275.42	$275.42	$275.42
Moda Health Facility/Professional Professional Modifier AA Low / Median / High Price $371.54 / $758.58 / $1,174.90	Professional	AA	$371.54	$758.58	$1,174.90
Moda Health Facility/Professional Professional Modifier QK Low / Median / High Price $190.55 / $323.59 / $616.60	Professional	QK	$190.55	$323.59	$616.60
Moda Health Facility/Professional Professional Modifier QX Low / Median / High Price $190.55 / $338.84 / $616.60	Professional	QX	$190.55	$338.84	$616.60
Moda Health Facility/Professional Professional Modifier QY Low / Median / High Price $213.80 / $338.84 / $691.83	Professional	QY	$213.80	$338.84	$691.83
Moda Health Facility/Professional Professional Modifier QZ Low / Median / High Price $158.49 / $478.63 / $758.58	Professional	QZ	$158.49	$478.63	$758.58
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,412.54 / $2,951.21 / $4,677.35	Facility		$1,412.54	$2,951.21	$4,677.35
Providence Facility/Professional Facility Modifier Low / Median / High Price $41.69 / $2,630.27 / $5,888.44	Facility		$41.69	$2,630.27	$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