Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $30.00 / $60.00 / $375.00	Facility		$30.00	$60.00	$375.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $350.69 / $442.38 / $585.44	Professional	AA	$350.69	$442.38	$585.44
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $259.66 / $345.24 / $485.05	Professional	QK	$259.66	$345.24	$485.05
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $247.51 / $333.75 / $495.71	Professional	QX	$247.51	$333.75	$495.71
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $253.65 / $297.93 / $401.29	Professional	QY	$253.65	$297.93	$401.29
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $122.31 / $566.02 / $577.52	Professional	QZ	$122.31	$566.02	$577.52
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $137.90 / $390.00 / $772.31	Professional	AA	$137.90	$390.00	$772.31
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $60.27 / $136.91 / $460.00	Professional	QK	$60.27	$136.91	$460.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $63.28 / $156.47 / $658.00	Professional	QX	$63.28	$156.47	$658.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $71.68 / $330.99 / $551.65	Professional	QY	$71.68	$330.99	$551.65
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $120.54 / $160.72 / $636.00	Professional	QZ	$120.54	$160.72	$636.00
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 $2,178.87 / $2,208.23 / $2,500.00	Facility		$2,178.87	$2,208.23	$2,500.00