Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $41.69 / $50.12 / $363.08	Facility		$41.69	$50.12	$363.08
Aetna Facility/Professional Facility Modifier AA Low / Median / High Price $5,128.61 / $5,128.61 / $5,370.32	Facility	AA	$5,128.61	$5,128.61	$5,370.32
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $446.68 / $870.96 / $1,380.38	Professional	AA	$446.68	$870.96	$1,380.38
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $194.98 / $371.54 / $645.65	Professional	QK	$194.98	$371.54	$645.65
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $223.87 / $380.19 / $660.69	Professional	QX	$223.87	$380.19	$660.69
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $229.09 / $346.74 / $562.34	Professional	QY	$229.09	$346.74	$562.34
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $223.87 / $501.19 / $794.33	Professional	QZ	$223.87	$501.19	$794.33
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $141.25 / $389.05 / $707.95	Professional	AA	$141.25	$389.05	$707.95
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $70.79 / $229.09 / $416.87	Professional	QK	$70.79	$229.09	$416.87
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $70.79 / $141.25 / $354.81	Professional	QX	$70.79	$141.25	$354.81
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $67.61 / $281.84 / $512.86	Professional	QY	$67.61	$281.84	$512.86
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $120.23 / $190.55 / $467.74	Professional	QZ	$120.23	$190.55	$467.74
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 $52.48 / $79.43 / $120.23	Facility		$52.48	$79.43	$120.23
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 $43.65 / $2,238.72 / $6,165.95	Facility		$43.65	$2,238.72	$6,165.95
Moda Health Facility/Professional Facility Modifier AA Low / Median / High Price $5,128.61 / $5,128.61 / $5,370.32	Facility	AA	$5,128.61	$5,128.61	$5,370.32
Moda Health Facility/Professional Professional Modifier AA Low / Median / High Price $380.19 / $794.33 / $1,348.96	Professional	AA	$380.19	$794.33	$1,348.96
Moda Health Facility/Professional Professional Modifier QK Low / Median / High Price $173.78 / $363.08 / $707.95	Professional	QK	$173.78	$363.08	$707.95
Moda Health Facility/Professional Professional Modifier QX Low / Median / High Price $204.17 / $380.19 / $707.95	Professional	QX	$204.17	$380.19	$707.95
Moda Health Facility/Professional Professional Modifier QY Low / Median / High Price $190.55 / $346.74 / $645.65	Professional	QY	$190.55	$346.74	$645.65
Moda Health Facility/Professional Professional Modifier QZ Low / Median / High Price $138.04 / $426.58 / $707.95	Professional	QZ	$138.04	$426.58	$707.95
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,380.38 / $2,951.21 / $4,677.35	Facility		$1,380.38	$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