Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $40.00 / $420.00 / $420.00	Facility		$40.00	$420.00	$420.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $172.21 / $840.00 / $1,661.88	Professional	AA	$172.21	$840.00	$1,661.88
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $316.51 / $514.99 / $745.67	Professional	QK	$316.51	$514.99	$745.67
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $103.50 / $538.46 / $931.39	Professional	QX	$103.50	$538.46	$931.39
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $88.50 / $401.29 / $531.17	Professional	QY	$88.50	$401.29	$531.17
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $145.78 / $340.80 / $728.00	Professional	QZ	$145.78	$340.80	$728.00
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $174.24 / $254.78 / $910.00	Professional	AA	$174.24	$254.78	$910.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $67.76 / $158.72 / $204.00	Professional	QK	$67.76	$158.72	$204.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $70.20 / $113.16 / $245.00	Professional	QX	$70.20	$113.16	$245.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $58.08 / $136.04 / $585.00	Professional	QY	$58.08	$136.04	$585.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $135.52 / $226.91 / $459.00	Professional	QZ	$135.52	$226.91	$459.00
Cigna Facility/Professional Professional Modifier QK Low / Median / High Price $180.00 / $180.00 / $180.00	Professional	QK	$180.00	$180.00	$180.00
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 / $360.00	Professional	QY	$180.00	$180.00	$360.00
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
United Facility/Professional Professional Modifier AA Low / Median / High Price $1,445.60 / $1,445.60 / $1,445.60	Professional	AA	$1,445.60	$1,445.60	$1,445.60
United Facility/Professional Professional Modifier QX Low / Median / High Price $80.00 / $80.00 / $85.00	Professional	QX	$80.00	$80.00	$85.00