Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $30.00 / $30.00 / $643.74	Facility		$30.00	$30.00	$643.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.00 / $38.00 / $453.66	Professional		$30.00	$38.00	$453.66
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $66.76 / $66.76 / $66.76	Professional	QX	$66.76	$66.76	$66.76
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $118.90 / $144.09 / $396.90	Professional	QZ	$118.90	$144.09	$396.90
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $123.92 / $123.92 / $123.92	Professional	QX	$123.92	$123.92	$123.92
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $123.92 / $123.92 / $123.92	Professional	QY	$123.92	$123.92	$123.92
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $36.51 / $306.00 / $408.00	Professional	QZ	$36.51	$306.00	$408.00
BCBS Facility/Professional Professional Modifier AA Low / Median / High Price $175.00 / $292.50 / $425.90	Professional	AA	$175.00	$292.50	$425.90
BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $49.45 / $87.50 / $189.05	Professional	QX	$49.45	$87.50	$189.05
BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $140.00 / $200.00 / $302.50	Professional	QZ	$140.00	$200.00	$302.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $225.00 / $375.00 / $632.35	Professional		$225.00	$375.00	$632.35
Medcost Facility/Professional Facility Modifier Low / Median / High Price $1,800.00 / $2,100.00 / $3,000.00	Facility		$1,800.00	$2,100.00	$3,000.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $225.00 / $225.00 / $507.50	Professional		$225.00	$225.00	$507.50
United Facility/Professional Professional Modifier Low / Median / High Price $42.00 / $65.00 / $80.00	Professional		$42.00	$65.00	$80.00