Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $30.00 / $60.00 / $403.20	Facility		$30.00	$60.00	$403.20
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $409.50 / $534.88 / $650.86	Professional	AA	$409.50	$534.88	$650.86
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $252.09 / $348.35 / $490.43	Professional	QK	$252.09	$348.35	$490.43
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $249.20 / $348.35 / $507.30	Professional	QX	$249.20	$348.35	$507.30
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $254.93 / $320.39 / $417.10	Professional	QY	$254.93	$320.39	$417.10
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $403.00 / $595.86 / $632.61	Professional	QZ	$403.00	$595.86	$632.61
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $122.88 / $325.00 / $690.00	Professional	AA	$122.88	$325.00	$690.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $52.74 / $257.13 / $342.84	Professional	QK	$52.74	$257.13	$342.84
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $51.23 / $162.50 / $437.50	Professional	QX	$51.23	$162.50	$437.50
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $50.23 / $195.00 / $471.41	Professional	QY	$50.23	$195.00	$471.41
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $100.45 / $156.69 / $665.00	Professional	QZ	$100.45	$156.69	$665.00
CareSource Facility/Professional Facility Modifier Low / Median / High Price $81.23 / $151.55 / $313.32	Facility		$81.23	$151.55	$313.32
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 $1,625.05 / $1,716.11 / $2,150.00	Facility		$1,625.05	$1,716.11	$2,150.00