Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $30.20 / $389.05 / $446.68	Facility		$30.20	$389.05	$446.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $47.86 / $562.34	Professional		$30.20	$47.86	$562.34
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $389.05 / $389.05 / $616.60	Professional	AA	$389.05	$389.05	$616.60
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
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $77.62 / $144.54 / $691.83	Professional	QX	$77.62	$144.54	$691.83
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $117.49 / $144.54 / $389.05	Professional	QZ	$117.49	$144.54	$389.05
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $257.04 / $389.05	Professional		$173.78	$257.04	$389.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $346.74 / $549.54	Professional		$223.87	$346.74	$549.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $489.78 / $794.33	Professional		$229.09	$489.78	$794.33
Kaiser Permanente Facility/Professional Professional Modifier QK Low / Median / High Price $147.91 / $147.91 / $199.53	Professional	QK	$147.91	$147.91	$199.53
Kaiser Permanente Facility/Professional Professional Modifier QX Low / Median / High Price $147.91 / $147.91 / $199.53	Professional	QX	$147.91	$147.91	$199.53
Kaiser Permanente Facility/Professional Professional Modifier QY Low / Median / High Price $147.91 / $147.91 / $199.53	Professional	QY	$147.91	$147.91	$199.53
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $7.59 / $23.44 / $81.28	Professional		$7.59	$23.44	$81.28
United Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $67.61 / $89.13	Professional		$50.12	$67.61	$89.13