Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $30.20 / $323.59 / $371.54	Facility		$30.20	$323.59	$371.54
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $134.90 / $537.03 / $724.44	Professional	AA	$134.90	$537.03	$724.44
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $89.13 / $302.00 / $416.87	Professional	QX	$89.13	$302.00	$416.87
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $245.47 / $295.12 / $354.81	Professional	QY	$245.47	$295.12	$354.81
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $120.23 / $562.34 / $691.83	Professional	QZ	$120.23	$562.34	$691.83
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $29.51 / $177.83 / $676.08	Professional	AA	$29.51	$177.83	$676.08
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $72.44 / $117.49 / $346.74	Professional	QX	$72.44	$117.49	$346.74
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $77.62 / $295.12 / $389.05	Professional	QY	$77.62	$295.12	$389.05
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $117.49 / $158.49 / $776.25	Professional	QZ	$117.49	$158.49	$776.25
CareSource Facility/Professional Facility Modifier Low / Median / High Price $194.98 / $194.98 / $194.98	Facility		$194.98	$194.98	$194.98
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $407.38 / $660.69	Professional		$190.55	$407.38	$660.69
Kaiser Permanente Facility/Professional Professional Modifier QK Low / Median / High Price $123.03 / $123.03 / $165.96	Professional	QK	$123.03	$123.03	$165.96
Kaiser Permanente Facility/Professional Professional Modifier QX Low / Median / High Price $123.03 / $123.03 / $165.96	Professional	QX	$123.03	$123.03	$165.96
Kaiser Permanente Facility/Professional Professional Modifier QY Low / Median / High Price $123.03 / $123.03 / $165.96	Professional	QY	$123.03	$123.03	$165.96
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $3,235.94 / $5,495.41 / $7,413.10	Facility		$3,235.94	$5,495.41	$7,413.10