Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $40.74 / $870.96 / $1,318.26	Facility		$40.74	$870.96	$1,318.26
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $128.82 / $660.69 / $1,148.15	Professional	AA	$128.82	$660.69	$1,148.15
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $91.20 / $331.13 / $549.54	Professional	QX	$91.20	$331.13	$549.54
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $239.88 / $302.00 / $446.68	Professional	QY	$239.88	$302.00	$446.68
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $125.89 / $380.19 / $660.69	Professional	QZ	$125.89	$380.19	$660.69
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $389.05 / $478.63 / $776.25	Professional	AA	$389.05	$478.63	$776.25
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $107.15 / $331.13 / $549.54	Professional	QX	$107.15	$331.13	$549.54
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $295.12 / $331.13 / $389.05	Professional	QY	$295.12	$331.13	$389.05
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $354.81 / $478.63 / $912.01	Professional	QZ	$354.81	$478.63	$912.01
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $158.49 / $371.54	Professional		$89.13	$158.49	$371.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $239.88 / $426.58	Professional		$112.20	$239.88	$426.58
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $141.25 / $141.25	Facility		$141.25	$141.25	$141.25
Lucent Health Facility/Professional Facility Modifier QK Low / Median / High Price $52.48 / $52.48 / $52.48	Facility	QK	$52.48	$52.48	$52.48
Lucent Health Facility/Professional Facility Modifier QX Low / Median / High Price $52.48 / $52.48 / $52.48	Facility	QX	$52.48	$52.48	$52.48
Lucent Health Facility/Professional Facility Modifier QY Low / Median / High Price $52.48 / $52.48 / $52.48	Facility	QY	$52.48	$52.48	$52.48
Providence Facility/Professional Facility Modifier Low / Median / High Price $2,089.30 / $4,073.80 / $5,623.41	Facility		$2,089.30	$4,073.80	$5,623.41
Providence Facility/Professional Professional Modifier QX Low / Median / High Price $151.36 / $151.36 / $151.36	Professional	QX	$151.36	$151.36	$151.36
Providence Facility/Professional Professional Modifier QY Low / Median / High Price $151.36 / $151.36 / $151.36	Professional	QY	$151.36	$151.36	$151.36