Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $93.33 / $426.58 / $524.81	Facility		$93.33	$426.58	$524.81
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $478.63 / $851.14 / $1,412.54	Professional	AA	$478.63	$851.14	$1,412.54
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $93.33 / $416.87 / $724.44	Professional	QK	$93.33	$416.87	$724.44
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $93.33 / $446.68 / $707.95	Professional	QX	$93.33	$446.68	$707.95
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $257.04 / $371.54 / $676.08	Professional	QY	$257.04	$371.54	$676.08
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $141.25 / $457.09 / $891.25	Professional	QZ	$141.25	$457.09	$891.25
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $204.17 / $501.19 / $758.58	Professional	AA	$204.17	$501.19	$758.58
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $141.25 / $177.83 / $239.88	Professional	QK	$141.25	$177.83	$239.88
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $141.25 / $177.83 / $263.03	Professional	QX	$141.25	$177.83	$263.03
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $114.82 / $138.04 / $263.03	Professional	QY	$114.82	$138.04	$263.03
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $141.25 / $229.09 / $741.31	Professional	QZ	$141.25	$229.09	$741.31
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $151.36 / $251.19 / $309.03	Facility		$151.36	$251.19	$309.03
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $281.84 / $309.03 / $446.68	Facility		$281.84	$309.03	$446.68