Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $582.47 / $861.70 / $1,170.00	Professional	AA	$582.47	$861.70	$1,170.00
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $589.84 / $737.30 / $823.24	Professional	QZ	$589.84	$737.30	$823.24
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $168.76 / $386.73 / $1,371.36	Professional	AA	$168.76	$386.73	$1,371.36
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $140.63 / $182.82 / $301.35	Professional	QZ	$140.63	$182.82	$301.35
Kaiser Permanente Facility/Professional Professional Modifier QK Low / Median / High Price $147.47 / $147.47 / $197.40	Professional	QK	$147.47	$147.47	$197.40
Kaiser Permanente Facility/Professional Professional Modifier QX Low / Median / High Price $147.47 / $147.47 / $197.40	Professional	QX	$147.47	$147.47	$197.40
Kaiser Permanente Facility/Professional Professional Modifier QY Low / Median / High Price $147.47 / $147.47 / $197.40	Professional	QY	$147.47	$147.47	$197.40