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 Facility Modifier QZ Low / Median / High Price $812.83 / $812.83 / $812.83	Facility	QZ	$812.83	$812.83	$812.83
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $380.19 / $724.44 / $1,071.52	Professional	AA	$380.19	$724.44	$1,071.52
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $234.42 / $371.54 / $630.96	Professional	QK	$234.42	$371.54	$630.96
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $177.83 / $380.19 / $616.60	Professional	QX	$177.83	$380.19	$616.60
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $239.88 / $338.84 / $588.84	Professional	QY	$239.88	$338.84	$588.84
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $346.74 / $588.84 / $870.96	Professional	QZ	$346.74	$588.84	$870.96
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $120.23 / $263.03 / $549.54	Professional	AA	$120.23	$263.03	$549.54
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $89.13 / $93.33 / $100.00	Professional	QK	$89.13	$93.33	$100.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $89.13 / $93.33 / $100.00	Professional	QX	$89.13	$93.33	$100.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $102.33 / $177.83 / $501.19	Professional	QZ	$102.33	$177.83	$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 $223.87 / $257.04 / $371.54	Facility		$223.87	$257.04	$371.54