Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $30.00 / $290.00 / $375.00	Facility		$30.00	$290.00	$375.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $377.30 / $377.30 / $377.30	Professional	AA	$377.30	$377.30	$377.30
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $778.75 / $778.75 / $901.71	Professional	QX	$778.75	$778.75	$901.71
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $498.58 / $498.58 / $498.58	Professional	QZ	$498.58	$498.58	$498.58
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $455.00 / $455.00 / $455.00	Professional	AA	$455.00	$455.00	$455.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $100.45 / $122.88 / $143.36	Professional	QZ	$100.45	$122.88	$143.36
CareSource Facility/Professional Facility Modifier Low / Median / High Price $101.55 / $152.33 / $391.65	Facility		$101.55	$152.33	$391.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $190.00 / $421.60 / $658.00	Professional		$190.00	$421.60	$658.00
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