Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $30.00 / $732.00 / $732.00	Facility		$30.00	$732.00	$732.00
Aetna Facility/Professional Facility Modifier QX Low / Median / High Price $92.12 / $107.52 / $194.88	Facility	QX	$92.12	$107.52	$194.88
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $135.44 / $805.00 / $922.23	Professional	AA	$135.44	$805.00	$922.23
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $79.31 / $413.21 / $724.61	Professional	QK	$79.31	$413.21	$724.61
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $73.62 / $401.23 / $730.60	Professional	QX	$73.62	$401.23	$730.60
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $339.25 / $396.75 / $461.11	Professional	QY	$339.25	$396.75	$461.11
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $129.47 / $151.15 / $390.00	Professional	QZ	$129.47	$151.15	$390.00
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $436.50 / $518.00 / $814.00	Professional	AA	$436.50	$518.00	$814.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $78.52 / $242.50 / $454.50	Professional	QK	$78.52	$242.50	$454.50
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $120.23 / $194.00 / $364.00	Professional	QX	$120.23	$194.00	$364.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $68.70 / $218.25 / $404.00	Professional	QY	$68.70	$218.25	$404.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $117.78 / $390.00 / $994.00	Professional	QZ	$117.78	$390.00	$994.00
Medcost Facility/Professional Facility Modifier Low / Median / High Price $1,200.00 / $1,950.00 / $3,990.00	Facility		$1,200.00	$1,950.00	$3,990.00
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $2,185.44 / $2,207.96 / $4,893.64	Facility		$2,185.44	$2,207.96	$4,893.64
United Facility/Professional Professional Modifier AA Low / Median / High Price $75.00 / $75.00 / $75.00	Professional	AA	$75.00	$75.00	$75.00
Wellcare Facility/Professional Facility Modifier Low / Median / High Price $82.00 / $82.00 / $82.00	Facility		$82.00	$82.00	$82.00
Wellcare Facility/Professional Facility Modifier QK Low / Median / High Price $37.00 / $37.00 / $39.50	Facility	QK	$37.00	$37.00	$39.50
Wellcare Facility/Professional Facility Modifier QX Low / Median / High Price $37.00 / $37.00 / $39.50	Facility	QX	$37.00	$37.00	$39.50
Wellcare Facility/Professional Facility Modifier QY Low / Median / High Price $37.00 / $37.00 / $39.50	Facility	QY	$37.00	$37.00	$39.50