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 Low / Median / High Price $38.00 / $45.00 / $354.00	Professional		$38.00	$45.00	$354.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $543.15 / $543.15 / $1,260.00	Professional	AA	$543.15	$543.15	$1,260.00
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $341.25 / $341.25 / $341.25	Professional	QX	$341.25	$341.25	$341.25
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $118.90 / $140.77 / $396.90	Professional	QZ	$118.90	$140.77	$396.90
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $390.00 / $390.00 / $455.00	Professional	AA	$390.00	$390.00	$455.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $153.00 / $195.00 / $227.50	Professional	QX	$153.00	$195.00	$227.50
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $195.00 / $195.00 / $195.00	Professional	QY	$195.00	$195.00	$195.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $120.30 / $408.00 / $455.00	Professional	QZ	$120.30	$408.00	$455.00
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
BCBS Facility/Professional Professional Modifier Low / Median / High Price $193.80 / $255.00 / $377.40	Professional		$193.80	$255.00	$377.40
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $240.00 / $357.00 / $528.00	Professional		$240.00	$357.00	$528.00
Christus Facility/Professional Facility Modifier Low / Median / High Price $20.17 / $170.23 / $170.23	Facility		$20.17	$170.23	$170.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $240.00 / $350.00 / $492.50	Professional		$240.00	$350.00	$492.50
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 / $104.00 / $104.00	Facility		$82.00	$104.00	$104.00
Lucent Health Facility/Professional Facility Modifier QK Low / Median / High Price $37.00 / $39.50 / $52.00	Facility	QK	$37.00	$39.50	$52.00
Lucent Health Facility/Professional Facility Modifier QX Low / Median / High Price $37.00 / $39.50 / $52.00	Facility	QX	$37.00	$39.50	$52.00
Lucent Health Facility/Professional Facility Modifier QY Low / Median / High Price $37.00 / $39.50 / $52.00	Facility	QY	$37.00	$39.50	$52.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,351.68 / $1,351.68 / $2,880.00	Professional		$1,351.68	$1,351.68	$2,880.00
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $2,846.10 / $5,350.00 / $6,105.00	Facility		$2,846.10	$5,350.00	$6,105.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $142.30 / $270.00 / $714.00	Professional		$142.30	$270.00	$714.00
Moda Health Facility/Professional Professional Modifier QY Low / Median / High Price $117.00 / $117.00 / $117.00	Professional	QY	$117.00	$117.00	$117.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $6.90 / $23.20 / $76.29	Professional		$6.90	$23.20	$76.29
Providence Facility/Professional Facility Modifier Low / Median / High Price $543.90 / $4,750.00 / $6,105.00	Facility		$543.90	$4,750.00	$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 Low / Median / High Price $250.00 / $352.25 / $490.00	Professional		$250.00	$352.25	$490.00
Providence Facility/Professional Professional Modifier QX Low / Median / High Price $174.00 / $216.00 / $234.69	Professional	QX	$174.00	$216.00	$234.69
Providence Facility/Professional Professional Modifier QY Low / Median / High Price $174.00 / $216.00 / $234.69	Professional	QY	$174.00	$216.00	$234.69
United Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $55.00 / $89.62	Professional		$50.00	$55.00	$89.62