Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $50.12 / $354.81 / $436.52	Facility		$50.12	$354.81	$436.52
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $380.19 / $831.76 / $1,230.27	Professional	AA	$380.19	$831.76	$1,230.27
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $83.18 / $354.81 / $660.69	Professional	QK	$83.18	$354.81	$660.69
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $89.13 / $363.08 / $630.96	Professional	QX	$89.13	$363.08	$630.96
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $229.09 / $309.03 / $616.60	Professional	QY	$229.09	$309.03	$616.60
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $158.49 / $478.63 / $870.96	Professional	QZ	$158.49	$478.63	$870.96
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $229.09 / $436.52 / $645.65	Professional	AA	$229.09	$436.52	$645.65
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $120.23 / $131.83 / $288.40	Professional	QK	$120.23	$131.83	$288.40
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $107.15 / $125.89 / $213.80	Professional	QX	$107.15	$125.89	$213.80
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $120.23 / $120.23 / $120.23	Professional	QY	$120.23	$120.23	$120.23
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $123.03 / $169.82 / $501.19	Professional	QZ	$123.03	$169.82	$501.19
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $151.36 / $251.19 / $309.03	Facility		$151.36	$251.19	$309.03
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $234.42 / $257.04 / $371.54	Facility		$234.42	$257.04	$371.54