Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $40.74 / $977.24 / $2,691.53	Facility		$40.74	$977.24	$2,691.53
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $407.38 / $851.14 / $1,479.11	Professional	AA	$407.38	$851.14	$1,479.11
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $117.49 / $407.38 / $724.44	Professional	QK	$117.49	$407.38	$724.44
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $147.91 / $416.87 / $741.31	Professional	QX	$147.91	$416.87	$741.31
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $239.88 / $363.08 / $676.08	Professional	QY	$239.88	$363.08	$676.08
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $141.25 / $426.58 / $1,348.96	Professional	QZ	$141.25	$426.58	$1,348.96
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $331.13 / $549.54 / $1,202.26	Professional	AA	$331.13	$549.54	$1,202.26
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $69.18 / $194.98 / $501.19	Professional	QK	$69.18	$194.98	$501.19
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $89.13 / $323.59 / $870.96	Professional	QX	$89.13	$323.59	$870.96
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $309.03 / $389.05 / $891.25	Professional	QY	$309.03	$389.05	$891.25
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $141.25 / $275.42 / $891.25	Professional	QZ	$141.25	$275.42	$891.25
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $147.91 / $346.74	Professional		$83.18	$147.91	$346.74
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $281.84 / $478.63	Professional		$134.90	$281.84	$478.63
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $104.71 / $104.71	Facility		$104.71	$104.71	$104.71
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 $87.10 / $3,630.78 / $5,623.41	Facility		$87.10	$3,630.78	$5,623.41
Providence Facility/Professional Professional Modifier QK Low / Median / High Price $181.97 / $181.97 / $181.97	Professional	QK	$181.97	$181.97	$181.97
Providence Facility/Professional Professional Modifier QX Low / Median / High Price $181.97 / $181.97 / $181.97	Professional	QX	$181.97	$181.97	$181.97
Providence Facility/Professional Professional Modifier QY Low / Median / High Price $181.97 / $181.97 / $181.97	Professional	QY	$181.97	$181.97	$181.97