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 Professional Modifier Low / Median / High Price $32.36 / $50.12 / $537.03	Professional		$32.36	$50.12	$537.03
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $389.05 / $616.60 / $2,238.72	Professional	AA	$389.05	$616.60	$2,238.72
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $295.12 / $371.54 / $549.54	Professional	QX	$295.12	$371.54	$549.54
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $295.12 / $309.03 / $489.78	Professional	QY	$295.12	$309.03	$489.78
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $109.65 / $134.90 / $346.74	Professional	QZ	$109.65	$134.90	$346.74
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $120.23 / $457.09 / $457.09	Professional	AA	$120.23	$457.09	$457.09
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $60.26 / $229.09 / $323.59	Professional	QX	$60.26	$229.09	$323.59
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $60.26 / $60.26 / $229.09	Professional	QY	$60.26	$60.26	$229.09
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $117.49 / $309.03 / $457.09	Professional	QZ	$117.49	$309.03	$457.09
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
BCBS Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $269.15 / $331.13	Professional		$204.17	$269.15	$331.13
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $331.13 / $524.81	Professional		$234.42	$331.13	$524.81
Christus Facility/Professional Facility Modifier Low / Median / High Price $39.81 / $169.82 / $169.82	Facility		$39.81	$169.82	$169.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $346.74 / $501.19	Professional		$239.88	$346.74	$501.19
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
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,348.96 / $2,884.03 / $2,884.03	Professional		$1,348.96	$2,884.03	$2,884.03
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $251.19 / $2,818.38 / $5,370.32	Facility		$251.19	$2,818.38	$5,370.32
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $338.84 / $602.56	Professional		$39.81	$338.84	$602.56
Moda Health Facility/Professional Professional Modifier AA Low / Median / High Price $389.05 / $616.60 / $2,238.72	Professional	AA	$389.05	$616.60	$2,238.72
Moda Health Facility/Professional Professional Modifier QX Low / Median / High Price $263.03 / $346.74 / $537.03	Professional	QX	$263.03	$346.74	$537.03
Moda Health Facility/Professional Professional Modifier QZ Low / Median / High Price $109.65 / $134.90 / $346.74	Professional	QZ	$109.65	$134.90	$346.74
Molina Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $371.54 / $758.58	Professional		$91.20	$371.54	$758.58
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $9.33 / $25.70 / $54.95	Professional		$9.33	$25.70	$54.95
Providence Facility/Professional Facility Modifier Low / Median / High Price $2,089.30 / $3,019.95 / $6,165.95	Facility		$2,089.30	$3,019.95	$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
Providence Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $346.74 / $478.63	Professional		$239.88	$346.74	$478.63
United Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $54.95 / $85.11	Professional		$46.77	$54.95	$85.11