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 Facility Modifier AA Low / Median / High Price $540.40 / $540.40 / $540.40	Facility	AA	$540.40	$540.40	$540.40
Aetna Facility/Professional Facility Modifier QK Low / Median / High Price $274.22 / $274.22 / $274.22	Facility	QK	$274.22	$274.22	$274.22
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $213.20 / $539.50 / $1,120.00	Professional	AA	$213.20	$539.50	$1,120.00
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $173.25 / $207.90 / $313.95	Professional	QK	$173.25	$207.90	$313.95
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $173.25 / $195.30 / $365.40	Professional	QX	$173.25	$195.30	$365.40
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $473.20 / $473.20 / $473.20	Professional	QY	$473.20	$473.20	$473.20
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $200.90 / $359.10 / $459.90	Professional	QZ	$200.90	$359.10	$459.90
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $132.00 / $455.00 / $747.00	Professional	AA	$132.00	$455.00	$747.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $114.86 / $274.75 / $460.00	Professional	QK	$114.86	$274.75	$460.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $73.81 / $227.50 / $352.38	Professional	QX	$73.81	$227.50	$352.38
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $50.13 / $153.00 / $424.00	Professional	QY	$50.13	$153.00	$424.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $120.30 / $390.00 / $640.00	Professional	QZ	$120.30	$390.00	$640.00
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 / $76.54 / $76.54	Facility		$20.17	$76.54	$76.54
Cigna Facility/Professional Professional Modifier QK Low / Median / High Price $150.00 / $150.00 / $150.00	Professional	QK	$150.00	$150.00	$150.00
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 / $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 $103.50 / $125.00 / $319.50	Professional	QK	$103.50	$125.00	$319.50
Moda Health Facility/Professional Professional Modifier QX Low / Median / High Price $45.50 / $112.80 / $300.00	Professional	QX	$45.50	$112.80	$300.00
Moda Health Facility/Professional Professional Modifier QY Low / Median / High Price $101.99 / $175.00 / $204.75	Professional	QY	$101.99	$175.00	$204.75
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $528.21 / $2,499.00 / $3,730.00	Facility		$528.21	$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 $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 QK Low / Median / High Price $145.00 / $180.00 / $196.50	Professional	QK	$145.00	$180.00	$196.50
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