Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.00 / $41.00 / $955.00	Facility		$38.00	$41.00	$955.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $128.90 / $840.00 / $1,260.00	Professional	AA	$128.90	$840.00	$1,260.00
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $415.47 / $529.00 / $819.95	Professional	QX	$415.47	$529.00	$819.95
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $73.61 / $445.69 / $512.13	Professional	QY	$73.61	$445.69	$512.13
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $308.92 / $476.00 / $973.50	Professional	AA	$308.92	$476.00	$973.50
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $50.13 / $318.04 / $386.40	Professional	QX	$50.13	$318.04	$386.40
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $93.29 / $93.29 / $292.50	Professional	QY	$93.29	$93.29	$292.50
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $101.50 / $390.00 / $490.00	Professional	QZ	$101.50	$390.00	$490.00
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $89.94 / $158.82 / $372.36	Professional		$89.94	$158.82	$372.36
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $162.33 / $260.00 / $440.00	Professional		$162.33	$260.00	$440.00
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $82.00 / $82.00 / $82.00	Facility		$82.00	$82.00	$82.00
Lucent Health Facility/Professional Facility Modifier QK Low / Median / High Price $37.00 / $37.00 / $39.50	Facility	QK	$37.00	$37.00	$39.50
Lucent Health Facility/Professional Facility Modifier QX Low / Median / High Price $37.00 / $37.00 / $39.50	Facility	QX	$37.00	$37.00	$39.50
Lucent Health Facility/Professional Facility Modifier QY Low / Median / High Price $37.00 / $37.00 / $39.50	Facility	QY	$37.00	$37.00	$39.50
Providence Facility/Professional Facility Modifier Low / Median / High Price $453.25 / $3,800.00 / $4,100.00	Facility		$453.25	$3,800.00	$4,100.00
Providence Facility/Professional Facility Modifier QK Low / Median / High Price $203.50 / $203.50 / $203.50	Facility	QK	$203.50	$203.50	$203.50
Providence Facility/Professional Facility Modifier QX Low / Median / High Price $203.50 / $203.50 / $203.50	Facility	QX	$203.50	$203.50	$203.50
Providence Facility/Professional Facility Modifier QY Low / Median / High Price $203.50 / $203.50 / $203.50	Facility	QY	$203.50	$203.50	$203.50
Providence Facility/Professional Professional Modifier QX Low / Median / High Price $145.00 / $181.00 / $206.30	Professional	QX	$145.00	$181.00	$206.30
Providence Facility/Professional Professional Modifier QY Low / Median / High Price $145.00 / $181.00 / $206.30	Professional	QY	$145.00	$181.00	$206.30