Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.00 / $330.00 / $1,146.00	Facility		$38.00	$330.00	$1,146.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $497.70 / $1,005.10 / $1,540.00	Professional	AA	$497.70	$1,005.10	$1,540.00
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $390.75 / $563.25 / $865.00	Professional	QK	$390.75	$563.25	$865.00
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $419.15 / $623.63 / $860.45	Professional	QX	$419.15	$623.63	$860.45
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $334.88 / $592.04 / $1,206.96	Professional	QY	$334.88	$592.04	$1,206.96
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $142.76 / $329.75 / $364.46	Professional	QZ	$142.76	$329.75	$364.46
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $234.47 / $585.00 / $1,170.00	Professional	AA	$234.47	$585.00	$1,170.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $112.34 / $458.15 / $688.50	Professional	QK	$112.34	$458.15	$688.50
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $109.53 / $658.00 / $846.00	Professional	QX	$109.53	$658.00	$846.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $61.44 / $367.50 / $780.00	Professional	QY	$61.44	$367.50	$780.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $142.10 / $273.00 / $490.00	Professional	QZ	$142.10	$273.00	$490.00
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $84.06 / $148.43 / $348.00	Professional		$84.06	$148.43	$348.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $181.20 / $300.00 / $505.80	Professional		$181.20	$300.00	$505.80
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 $488.40 / $3,375.00 / $4,100.00	Facility		$488.40	$3,375.00	$4,100.00
Providence Facility/Professional Facility Modifier QK Low / Median / High Price $244.20 / $244.20 / $244.20	Facility	QK	$244.20	$244.20	$244.20
Providence Facility/Professional Facility Modifier QX Low / Median / High Price $244.20 / $244.20 / $244.20	Facility	QX	$244.20	$244.20	$244.20
Providence Facility/Professional Facility Modifier QY Low / Median / High Price $244.20 / $244.20 / $244.20	Facility	QY	$244.20	$244.20	$244.20
Providence Facility/Professional Professional Modifier QK Low / Median / High Price $174.00 / $217.20 / $247.56	Professional	QK	$174.00	$217.20	$247.56
Providence Facility/Professional Professional Modifier QX Low / Median / High Price $174.00 / $217.20 / $247.56	Professional	QX	$174.00	$217.20	$247.56
Providence Facility/Professional Professional Modifier QY Low / Median / High Price $174.00 / $217.20 / $247.56	Professional	QY	$174.00	$217.20	$247.56
United Facility/Professional Professional Modifier AA Low / Median / High Price $365.00 / $582.00 / $1,445.60	Professional	AA	$365.00	$582.00	$1,445.60
United Facility/Professional Professional Modifier QX Low / Median / High Price $85.00 / $85.00 / $85.00	Professional	QX	$85.00	$85.00	$85.00