Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $800.80 / $800.80 / $1,262.80	Professional	AA	$800.80	$800.80	$1,262.80
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $177.30 / $177.30 / $177.30	Professional	AA	$177.30	$177.30	$177.30
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $104.45 / $122.88 / $261.17	Professional	QZ	$104.45	$122.88	$261.17
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