Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $218.78 / $218.78 / $218.78	Professional	QZ	$218.78	$218.78	$218.78
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $131.83 / $131.83 / $165.96	Professional	QZ	$131.83	$131.83	$165.96
Kaiser Permanente Facility/Professional Professional Modifier QK Low / Median / High Price $97.72 / $97.72 / $131.83	Professional	QK	$97.72	$97.72	$131.83
Kaiser Permanente Facility/Professional Professional Modifier QX Low / Median / High Price $97.72 / $97.72 / $131.83	Professional	QX	$97.72	$97.72	$131.83
Kaiser Permanente Facility/Professional Professional Modifier QY Low / Median / High Price $97.72 / $97.72 / $131.83	Professional	QY	$97.72	$97.72	$131.83