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 $141.25 / $707.95 / $1,096.48	Professional	AA	$141.25	$707.95	$1,096.48
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $154.88 / $323.59 / $549.54	Professional	QX	$154.88	$323.59	$549.54
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $234.42 / $309.03 / $478.63	Professional	QY	$234.42	$309.03	$478.63
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $123.03 / $416.87 / $831.76	Professional	QZ	$123.03	$416.87	$831.76
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $93.33 / $323.59 / $588.84	Professional	AA	$93.33	$323.59	$588.84
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $50.12 / $81.28 / $229.09	Professional	QX	$50.12	$81.28	$229.09
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $60.26 / $245.47 / $295.12	Professional	QY	$60.26	$245.47	$295.12
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $104.71 / $158.49 / $478.63	Professional	QZ	$104.71	$158.49	$478.63
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 / $128.82 / $128.82	Facility		$39.81	$128.82	$128.82
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $141.25 / $141.25	Facility		$141.25	$141.25	$141.25
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 $208.93 / $2,754.23 / $5,888.44	Facility		$208.93	$2,754.23	$5,888.44
Moda Health Facility/Professional Professional Modifier AA Low / Median / High Price $120.23 / $645.65 / $1,071.52	Professional	AA	$120.23	$645.65	$1,071.52
Moda Health Facility/Professional Professional Modifier QX Low / Median / High Price $81.28 / $346.74 / $588.84	Professional	QX	$81.28	$346.74	$588.84
Moda Health Facility/Professional Professional Modifier QY Low / Median / High Price $154.88 / $346.74 / $588.84	Professional	QY	$154.88	$346.74	$588.84
Moda Health Facility/Professional Professional Modifier QZ Low / Median / High Price $123.03 / $398.11 / $776.25	Professional	QZ	$123.03	$398.11	$776.25
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $3,388.44 / $5,370.32 / $5,623.41	Facility		$3,388.44	$5,370.32	$5,623.41
Providence Facility/Professional Facility Modifier Low / Median / High Price $2,089.30 / $3,162.28 / $6,165.95	Facility		$2,089.30	$3,162.28	$6,165.95
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