Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $30.20 / $363.08 / $446.68	Facility		$30.20	$363.08	$446.68
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $288.40 / $588.84 / $851.14	Professional	AA	$288.40	$588.84	$851.14
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $128.82 / $354.81 / $537.03	Professional	QK	$128.82	$354.81	$537.03
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $151.36 / $354.81 / $549.54	Professional	QX	$151.36	$354.81	$549.54
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $257.04 / $338.84 / $489.78	Professional	QY	$257.04	$338.84	$489.78
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $151.36 / $537.03 / $645.65	Professional	QZ	$151.36	$537.03	$645.65
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $138.04 / $457.09 / $912.01	Professional	AA	$138.04	$457.09	$912.01
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $69.18 / $93.33 / $416.87	Professional	QK	$69.18	$93.33	$416.87
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $72.44 / $138.04 / $478.63	Professional	QX	$72.44	$138.04	$478.63
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $61.66 / $138.04 / $501.19	Professional	QY	$61.66	$138.04	$501.19
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $120.23 / $186.21 / $812.83	Professional	QZ	$120.23	$186.21	$812.83
CareSource Facility/Professional Facility Modifier Low / Median / High Price $229.09 / $229.09 / $229.09	Facility		$229.09	$229.09	$229.09
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 Facility Modifier Low / Median / High Price $2,187.76 / $3,548.13 / $6,025.60	Facility		$2,187.76	$3,548.13	$6,025.60