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 $380.19 / $758.58 / $1,071.52	Professional	AA	$380.19	$758.58	$1,071.52
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $208.93 / $323.59 / $562.34	Professional	QK	$208.93	$323.59	$562.34
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $208.93 / $331.13 / $588.84	Professional	QX	$208.93	$331.13	$588.84
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $223.87 / $338.84 / $549.54	Professional	QY	$223.87	$338.84	$549.54
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $309.03 / $457.09 / $707.95	Professional	QZ	$309.03	$457.09	$707.95
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $100.00 / $380.19 / $588.84	Professional	AA	$100.00	$380.19	$588.84
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $60.26 / $194.98 / $316.23	Professional	QK	$60.26	$194.98	$316.23
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $51.29 / $85.11 / $275.42	Professional	QX	$51.29	$85.11	$275.42
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $52.48 / $95.50 / $323.59	Professional	QY	$52.48	$95.50	$323.59
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $97.72 / $125.89 / $457.09	Professional	QZ	$97.72	$125.89	$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 / $72.44 / $72.44	Facility		$39.81	$72.44	$72.44
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 / $2,238.72 / $6,165.95	Facility		$45.71	$2,238.72	$6,165.95
Moda Health Facility/Professional Professional Modifier AA Low / Median / High Price $380.19 / $707.95 / $1,047.13	Professional	AA	$380.19	$707.95	$1,047.13
Moda Health Facility/Professional Professional Modifier QK Low / Median / High Price $190.55 / $316.23 / $630.96	Professional	QK	$190.55	$316.23	$630.96
Moda Health Facility/Professional Professional Modifier QX Low / Median / High Price $194.98 / $331.13 / $616.60	Professional	QX	$194.98	$331.13	$616.60
Moda Health Facility/Professional Professional Modifier QY Low / Median / High Price $181.97 / $389.05 / $691.83	Professional	QY	$181.97	$389.05	$691.83
Moda Health Facility/Professional Professional Modifier QZ Low / Median / High Price $288.40 / $446.68 / $691.83	Professional	QZ	$288.40	$446.68	$691.83
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,445.44 / $2,137.96 / $3,388.44	Facility		$1,445.44	$2,137.96	$3,388.44
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