Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $288.40 / $416.87 / $724.44	Facility		$288.40	$416.87	$724.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $47.86 / $645.65	Professional		$30.20	$47.86	$645.65
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $389.05 / $616.60 / $776.25	Professional	AA	$389.05	$616.60	$776.25
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $269.15 / $371.54 / $549.54	Professional	QX	$269.15	$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 $120.23 / $138.04 / $436.52	Professional	QZ	$120.23	$138.04	$436.52
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $77.62 / $151.36 / $691.83	Professional	QX	$77.62	$151.36	$691.83
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $97.72 / $97.72 / $97.72	Professional	QY	$97.72	$97.72	$97.72
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $123.03 / $144.54 / $354.81	Professional	QZ	$123.03	$144.54	$354.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $371.54 / $562.34	Professional		$223.87	$371.54	$562.34
Medcost Facility/Professional Facility Modifier Low / Median / High Price $1,737.80 / $2,570.40 / $4,677.35	Facility		$1,737.80	$2,570.40	$4,677.35
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $5.01 / $21.88 / $89.13	Professional		$5.01	$21.88	$89.13
United Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $61.66 / $100.00	Professional		$39.81	$61.66	$100.00
Wellcare Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $104.71 / $104.71	Facility		$104.71	$104.71	$104.71
Wellcare Facility/Professional Facility Modifier QK Low / Median / High Price $52.48 / $52.48 / $52.48	Facility	QK	$52.48	$52.48	$52.48
Wellcare Facility/Professional Facility Modifier QX Low / Median / High Price $52.48 / $52.48 / $52.48	Facility	QX	$52.48	$52.48	$52.48
Wellcare Facility/Professional Facility Modifier QY Low / Median / High Price $52.48 / $52.48 / $52.48	Facility	QY	$52.48	$52.48	$52.48
Wellcare 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