Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $42.00 / $50.00 / $363.60	Facility		$42.00	$50.00	$363.60
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $459.90 / $805.80 / $1,400.00	Professional	AA	$459.90	$805.80	$1,400.00
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $185.85 / $255.15 / $390.60	Professional	QK	$185.85	$255.15	$390.60
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $179.55 / $245.70 / $391.30	Professional	QX	$179.55	$245.70	$391.30
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $179.55 / $273.00 / $377.65	Professional	QY	$179.55	$273.00	$377.65
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $112.75 / $371.70 / $422.10	Professional	QZ	$112.75	$371.70	$422.10
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $154.00 / $520.00 / $720.00	Professional	AA	$154.00	$520.00	$720.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $70.18 / $227.50 / $382.50	Professional	QK	$70.18	$227.50	$382.50
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $73.81 / $260.00 / $402.72	Professional	QX	$73.81	$260.00	$402.72
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $88.00 / $314.00 / $353.25	Professional	QY	$88.00	$314.00	$353.25
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $140.35 / $390.00 / $744.00	Professional	QZ	$140.35	$390.00	$744.00
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 $40.00 / $80.11 / $120.30	Facility		$40.00	$80.11	$120.30
Cigna Facility/Professional Professional Modifier QK Low / Median / High Price $180.00 / $180.00 / $180.00	Professional	QK	$180.00	$180.00	$180.00
Cigna Facility/Professional Professional Modifier QX Low / Median / High Price $180.00 / $180.00 / $180.00	Professional	QX	$180.00	$180.00	$180.00
Cigna Facility/Professional Professional Modifier QY Low / Median / High Price $180.00 / $180.00 / $180.00	Professional	QY	$180.00	$180.00	$180.00
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
Moda Health Facility/Professional Professional Modifier QK Low / Median / High Price $83.31 / $139.50 / $324.00	Professional	QK	$83.31	$139.50	$324.00
Moda Health Facility/Professional Professional Modifier QX Low / Median / High Price $107.25 / $152.25 / $339.60	Professional	QX	$107.25	$152.25	$339.60
Moda Health Facility/Professional Professional Modifier QY Low / Median / High Price $9.92 / $293.63 / $464.91	Professional	QY	$9.92	$293.63	$464.91
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $433.15 / $2,499.00 / $3,730.00	Facility		$433.15	$2,499.00	$3,730.00
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 $244.20 / $244.20 / $244.20	Facility	QK	$244.20	$244.20	$244.20
Providence Facility/Professional Facility Modifier QX Low / Median / High Price $244.20 / $244.20 / $244.20	Facility	QX	$244.20	$244.20	$244.20
Providence Facility/Professional Facility Modifier QY Low / Median / High Price $244.20 / $244.20 / $244.20	Facility	QY	$244.20	$244.20	$244.20
Providence Facility/Professional Professional Modifier QK Low / Median / High Price $174.00 / $216.00 / $262.70	Professional	QK	$174.00	$216.00	$262.70
Providence Facility/Professional Professional Modifier QX Low / Median / High Price $174.00 / $216.00 / $262.70	Professional	QX	$174.00	$216.00	$262.70
Providence Facility/Professional Professional Modifier QY Low / Median / High Price $174.00 / $216.00 / $262.70	Professional	QY	$174.00	$216.00	$262.70
United Facility/Professional Professional Modifier AA Low / Median / High Price $75.00 / $75.00 / $365.00	Professional	AA	$75.00	$75.00	$365.00
United Facility/Professional Professional Modifier QX Low / Median / High Price $80.00 / $85.00 / $85.00	Professional	QX	$80.00	$85.00	$85.00