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 Low / Median / High Price $30.00 / $42.00 / $582.00	Professional		$30.00	$42.00	$582.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $500.50 / $500.50 / $500.50	Professional	AA	$500.50	$500.50	$500.50
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
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $126.16 / $471.41 / $642.83	Professional	QX	$126.16	$471.41	$642.83
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $108.13 / $108.13 / $156.47	Professional	QY	$108.13	$108.13	$156.47
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $120.54 / $140.63 / $163.84	Professional	QZ	$120.54	$140.63	$163.84
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $183.60 / $258.00 / $578.58	Professional		$183.60	$258.00	$578.58
CareSource Facility/Professional Facility Modifier Low / Median / High Price $121.86 / $227.33 / $469.98	Facility		$121.86	$227.33	$469.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $240.00 / $380.00 / $551.45	Professional		$240.00	$380.00	$551.45
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 Professional Modifier Low / Median / High Price $7.50 / $30.14 / $97.34	Professional		$7.50	$30.14	$97.34
United Facility/Professional Professional Modifier Low / Median / High Price $53.00 / $72.00 / $90.00	Professional		$53.00	$72.00	$90.00