Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $30.00 / $464.00 / $600.00	Facility		$30.00	$464.00	$600.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $393.59 / $760.86 / $1,005.70	Professional	AA	$393.59	$760.86	$1,005.70
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $420.17 / $550.02 / $738.70	Professional	QK	$420.17	$550.02	$738.70
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $401.29 / $550.02 / $731.76	Professional	QX	$401.29	$550.02	$731.76
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $391.17 / $1,273.04 / $1,485.21	Professional	AA	$391.17	$1,273.04	$1,485.21
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $126.96 / $378.00 / $728.54	Professional	QK	$126.96	$378.00	$728.54
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $110.50 / $378.00 / $940.00	Professional	QX	$110.50	$378.00	$940.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $160.72 / $200.90 / $200.90	Professional	QZ	$160.72	$200.90	$200.90
CareSource Facility/Professional Facility Modifier Low / Median / High Price $162.47 / $303.10 / $626.64	Facility		$162.47	$303.10	$626.64
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $344.00 / $649.12 / $1,008.00	Professional		$344.00	$649.12	$1,008.00
Kaiser Permanente Facility/Professional Professional Modifier QK Low / Median / High Price $196.62 / $196.62 / $263.20	Professional	QK	$196.62	$196.62	$263.20
Kaiser Permanente Facility/Professional Professional Modifier QX Low / Median / High Price $196.62 / $196.62 / $263.20	Professional	QX	$196.62	$196.62	$263.20
Kaiser Permanente Facility/Professional Professional Modifier QY Low / Median / High Price $196.62 / $196.62 / $263.20	Professional	QY	$196.62	$196.62	$263.20