Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $50.50 / $344.00 / $434.80	Facility		$50.50	$344.00	$434.80
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $299.04 / $785.88 / $1,400.00	Professional	AA	$299.04	$785.88	$1,400.00
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $85.24 / $722.02 / $722.02	Professional	QX	$85.24	$722.02	$722.02
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $412.80 / $489.36 / $521.55	Professional	QZ	$412.80	$489.36	$521.55
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $210.00 / $432.00 / $600.00	Professional	AA	$210.00	$432.00	$600.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $131.44 / $189.00 / $418.60	Professional	QK	$131.44	$189.00	$418.60
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $97.44 / $106.62 / $131.44	Professional	QX	$97.44	$106.62	$131.44
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $97.44 / $97.44 / $97.44	Professional	QY	$97.44	$97.44	$97.44
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $121.80 / $219.24 / $498.00	Professional	QZ	$121.80	$219.24	$498.00
Cigna Facility/Professional Professional Modifier QK Low / Median / High Price $150.00 / $150.00 / $150.00	Professional	QK	$150.00	$150.00	$150.00
Cigna Facility/Professional Professional Modifier QX Low / Median / High Price $150.00 / $150.00 / $150.00	Professional	QX	$150.00	$150.00	$150.00
Cigna Facility/Professional Professional Modifier QY Low / Median / High Price $150.00 / $150.00 / $150.00	Professional	QY	$150.00	$150.00	$150.00
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $150.00 / $250.00 / $410.00	Facility		$150.00	$250.00	$410.00
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $224.67 / $260.00 / $376.25	Facility		$224.67	$260.00	$376.25