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 $346.50 / $505.60 / $980.00	Professional	AA	$346.50	$505.60	$980.00
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $170.10 / $207.90 / $264.60	Professional	QK	$170.10	$207.90	$264.60
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $98.25 / $207.90 / $365.40	Professional	QX	$98.25	$207.90	$365.40
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $163.80 / $185.85 / $214.20	Professional	QY	$163.80	$185.85	$214.20
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $315.00 / $365.40 / $422.10	Professional	QZ	$315.00	$365.40	$422.10
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $110.00 / $434.00 / $604.08	Professional	AA	$110.00	$434.00	$604.08
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $60.18 / $227.50 / $382.50	Professional	QK	$60.18	$227.50	$382.50
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $59.10 / $227.50 / $314.00	Professional	QX	$59.10	$227.50	$314.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $40.10 / $73.81 / $453.06	Professional	QY	$40.10	$73.81	$453.06
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $100.25 / $372.00 / $636.00	Professional	QZ	$100.25	$372.00	$636.00
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 / $72.90 / $72.90	Facility		$20.17	$72.90	$72.90
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 $8.82 / $87.83 / $162.50	Professional	QK	$8.82	$87.83	$162.50
Moda Health Facility/Professional Professional Modifier QX Low / Median / High Price $42.00 / $123.25 / $267.75	Professional	QX	$42.00	$123.25	$267.75
Moda Health Facility/Professional Professional Modifier QY Low / Median / High Price $116.00 / $116.00 / $159.25	Professional	QY	$116.00	$116.00	$159.25
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $304.57 / $2,499.00 / $3,419.00	Facility		$304.57	$2,499.00	$3,419.00
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