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 Facility Modifier QZ Low / Median / High Price $810.09 / $810.09 / $810.09	Facility	QZ	$810.09	$810.09	$810.09
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $406.70 / $615.00 / $1,120.00	Professional	AA	$406.70	$615.00	$1,120.00
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $138.32 / $138.32 / $138.32	Professional	QX	$138.32	$138.32	$138.32
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $371.39 / $598.00 / $602.58	Professional	QZ	$371.39	$598.00	$602.58
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $167.48 / $390.00 / $541.08	Professional	AA	$167.48	$390.00	$541.08
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $88.85 / $93.89 / $275.83	Professional	QK	$88.85	$93.89	$275.83
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $88.85 / $93.89 / $99.62	Professional	QX	$88.85	$93.89	$99.62
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $101.50 / $162.40 / $455.00	Professional	QZ	$101.50	$162.40	$455.00
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 $220.00 / $260.00 / $376.25	Facility		$220.00	$260.00	$376.25