Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $30.00 / $348.00 / $450.00	Facility		$30.00	$348.00	$450.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $393.91 / $566.02 / $731.80	Professional	AA	$393.91	$566.02	$731.80
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $275.01 / $389.60 / $536.27	Professional	QK	$275.01	$389.60	$536.27
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $275.01 / $403.35 / $568.35	Professional	QX	$275.01	$403.35	$568.35
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $279.58 / $348.35 / $444.60	Professional	QY	$279.58	$348.35	$444.60
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $129.47 / $501.03 / $577.52	Professional	QZ	$129.47	$501.03	$577.52
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $160.72 / $455.00 / $882.64	Professional	AA	$160.72	$455.00	$882.64
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $71.72 / $299.99 / $517.50	Professional	QK	$71.72	$299.99	$517.50
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $71.68 / $144.18 / $460.00	Professional	QX	$71.68	$144.18	$460.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $61.44 / $137.11 / $496.49	Professional	QY	$61.44	$137.11	$496.49
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $120.54 / $182.82 / $520.00	Professional	QZ	$120.54	$182.82	$520.00
CareSource Facility/Professional Facility Modifier Low / Median / High Price $121.86 / $227.33 / $469.98	Facility		$121.86	$227.33	$469.98
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $258.00 / $486.84 / $756.00	Professional		$258.00	$486.84	$756.00
Kaiser Permanente Facility/Professional Professional Modifier QK Low / Median / High Price $147.47 / $147.47 / $197.40	Professional	QK	$147.47	$147.47	$197.40
Kaiser Permanente Facility/Professional Professional Modifier QX Low / Median / High Price $147.47 / $147.47 / $197.40	Professional	QX	$147.47	$147.47	$197.40
Kaiser Permanente Facility/Professional Professional Modifier QY Low / Median / High Price $147.47 / $147.47 / $197.40	Professional	QY	$147.47	$147.47	$197.40
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,673.72 / $2,178.87 / $2,500.00	Facility		$1,673.72	$2,178.87	$2,500.00
United Facility/Professional Professional Modifier AA Low / Median / High Price $70.00 / $75.00 / $365.00	Professional	AA	$70.00	$75.00	$365.00
United Facility/Professional Professional Modifier QX Low / Median / High Price $80.00 / $85.00 / $360.00	Professional	QX	$80.00	$85.00	$360.00
United Facility/Professional Professional Modifier QY Low / Median / High Price $70.00 / $70.00 / $70.00	Professional	QY	$70.00	$70.00	$70.00