Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $30.20 / $302.00 / $371.54	Facility		$30.20	$302.00	$371.54
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $288.40 / $537.03 / $851.14	Professional	AA	$288.40	$537.03	$851.14
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $208.93 / $309.03 / $467.74	Professional	QK	$208.93	$309.03	$467.74
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $223.87 / $316.23 / $467.74	Professional	QX	$223.87	$316.23	$467.74
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $234.42 / $295.12 / $389.05	Professional	QY	$234.42	$295.12	$389.05
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $158.49 / $524.81 / $660.69	Professional	QZ	$158.49	$524.81	$660.69
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $162.18 / $389.05 / $794.33	Professional	AA	$162.18	$389.05	$794.33
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $60.26 / $91.20 / $398.11	Professional	QK	$60.26	$91.20	$398.11
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $63.10 / $120.23 / $398.11	Professional	QX	$63.10	$120.23	$398.11
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $63.10 / $281.84 / $549.54	Professional	QY	$63.10	$281.84	$549.54
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $117.49 / $165.96 / $645.65	Professional	QZ	$117.49	$165.96	$645.65
CareSource Facility/Professional Facility Modifier Low / Median / High Price $194.98 / $194.98 / $194.98	Facility		$194.98	$194.98	$194.98
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $407.38 / $660.69	Professional		$190.55	$407.38	$660.69
Kaiser Permanente Facility/Professional Professional Modifier QK Low / Median / High Price $123.03 / $123.03 / $165.96	Professional	QK	$123.03	$123.03	$165.96
Kaiser Permanente Facility/Professional Professional Modifier QX Low / Median / High Price $123.03 / $123.03 / $165.96	Professional	QX	$123.03	$123.03	$165.96
Kaiser Permanente Facility/Professional Professional Modifier QY Low / Median / High Price $123.03 / $123.03 / $165.96	Professional	QY	$123.03	$123.03	$165.96
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $2,398.83 / $5,495.41 / $6,025.60	Facility		$2,398.83	$5,495.41	$6,025.60