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 $101.95 / $346.50 / $980.00	Professional	AA	$101.95	$346.50	$980.00
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $267.75 / $267.75 / $415.47	Professional	QX	$267.75	$267.75	$415.47
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $267.75 / $267.75 / $267.75	Professional	QY	$267.75	$267.75	$267.75
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $121.78 / $371.70 / $422.10	Professional	QZ	$121.78	$371.70	$422.10
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $127.62 / $390.00 / $704.76	Professional	AA	$127.62	$390.00	$704.76
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $50.13 / $227.50 / $302.04	Professional	QX	$50.13	$227.50	$302.04
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $50.13 / $66.00 / $302.04	Professional	QY	$50.13	$66.00	$302.04
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $100.25 / $120.30 / $480.00	Professional	QZ	$100.25	$120.30	$480.00
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 / $129.60 / $129.60	Facility		$20.17	$129.60	$129.60
Cigna Facility/Professional Professional Modifier QX Low / Median / High Price $150.00 / $150.00 / $150.00	Professional	QX	$150.00	$150.00	$150.00
Cigna Facility/Professional Professional Modifier QY Low / Median / High Price $150.00 / $150.00 / $150.00	Professional	QY	$150.00	$150.00	$150.00
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $82.00 / $140.40 / $140.40	Facility		$82.00	$140.40	$140.40
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 $2,846.10 / $5,350.00 / $6,105.00	Facility		$2,846.10	$5,350.00	$6,105.00
Moda Health Facility/Professional Professional Modifier QX Low / Median / High Price $4.84 / $146.81 / $162.50	Professional	QX	$4.84	$146.81	$162.50
Moda Health Facility/Professional Professional Modifier QY Low / Median / High Price $81.67 / $156.00 / $341.85	Professional	QY	$81.67	$156.00	$341.85
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $581.30 / $2,499.00 / $5,879.51	Facility		$581.30	$2,499.00	$5,879.51
Providence Facility/Professional Facility Modifier Low / Median / High Price $453.25 / $4,750.00 / $6,105.00	Facility		$453.25	$4,750.00	$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 $145.00 / $180.00 / $196.50	Professional	QX	$145.00	$180.00	$196.50
Providence Facility/Professional Professional Modifier QY Low / Median / High Price $145.00 / $180.00 / $196.50	Professional	QY	$145.00	$180.00	$196.50