Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $297.42 / $391.60 / $627.94	Professional	QX	$297.42	$391.60	$627.94
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $473.23 / $473.23 / $473.23	Professional	QZ	$473.23	$473.23	$473.23
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $75.26 / $514.26 / $595.00	Professional	QX	$75.26	$514.26	$595.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $100.45 / $143.36 / $143.36	Professional	QZ	$100.45	$143.36	$143.36
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