Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $30.00 / $290.00 / $375.00	Facility		$30.00	$290.00	$375.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $474.50 / $552.50 / $589.84	Professional	AA	$474.50	$552.50	$589.84
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $115.50 / $302.14 / $385.01	Professional	QX	$115.50	$302.14	$385.01
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $242.93 / $275.01 / $316.31	Professional	QY	$242.93	$275.01	$316.31
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $120.54 / $234.70 / $599.97	Professional	AA	$120.54	$234.70	$599.97
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $76.18 / $252.00 / $772.31	Professional	QX	$76.18	$252.00	$772.31
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $136.91 / $252.00 / $386.16	Professional	QY	$136.91	$252.00	$386.16
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $117.06 / $160.72 / $570.00	Professional	QZ	$117.06	$160.72	$570.00
CareSource Facility/Professional Facility Modifier Low / Median / High Price $101.55 / $189.44 / $391.65	Facility		$101.55	$189.44	$391.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $215.00 / $405.70 / $630.00	Professional		$215.00	$405.70	$630.00
Kaiser Permanente Facility/Professional Professional Modifier QK Low / Median / High Price $122.89 / $122.89 / $164.50	Professional	QK	$122.89	$122.89	$164.50
Kaiser Permanente Facility/Professional Professional Modifier QX Low / Median / High Price $122.89 / $122.89 / $164.50	Professional	QX	$122.89	$122.89	$164.50
Kaiser Permanente Facility/Professional Professional Modifier QY Low / Median / High Price $122.89 / $122.89 / $164.50	Professional	QY	$122.89	$122.89	$164.50
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $2,363.12 / $2,363.12 / $3,250.00	Facility		$2,363.12	$2,363.12	$3,250.00