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 Low / Median / High Price $30.00 / $41.00 / $408.00	Professional		$30.00	$41.00	$408.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $1,260.00 / $1,260.00 / $1,260.00	Professional	AA	$1,260.00	$1,260.00	$1,260.00
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $293.70 / $380.43 / $545.44	Professional	QX	$293.70	$380.43	$545.44
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $293.70 / $311.50 / $490.43	Professional	QY	$293.70	$311.50	$490.43
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $364.80 / $364.80 / $364.80	Professional	QZ	$364.80	$364.80	$364.80
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $226.74 / $226.74 / $226.74	Professional	QX	$226.74	$226.74	$226.74
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $226.74 / $226.74 / $226.74	Professional	QY	$226.74	$226.74	$226.74
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $136.57 / $140.41 / $408.00	Professional	QZ	$136.57	$140.41	$408.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $210.00 / $345.00 / $560.00	Professional		$210.00	$345.00	$560.00
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
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
United Facility/Professional Professional Modifier Low / Median / High Price $40.00 / $56.00 / $90.00	Professional		$40.00	$56.00	$90.00