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 $316.24 / $890.95 / $1,270.42	Professional	AA	$316.24	$890.95	$1,270.42
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $364.00 / $558.54 / $734.14	Professional	QK	$364.00	$558.54	$734.14
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $415.47 / $562.05 / $868.71	Professional	QX	$415.47	$562.05	$868.71
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $336.50 / $468.84 / $684.71	Professional	QY	$336.50	$468.84	$684.71
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $200.90 / $329.75 / $399.17	Professional	QZ	$200.90	$329.75	$399.17
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $390.00 / $544.00 / $1,040.00	Professional	AA	$390.00	$544.00	$1,040.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $72.56 / $291.55 / $418.60	Professional	QK	$72.56	$291.55	$418.60
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $55.17 / $337.77 / $752.00	Professional	QX	$55.17	$337.77	$752.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $71.68 / $337.77 / $585.00	Professional	QY	$71.68	$337.77	$585.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $121.80 / $234.00 / $490.00	Professional	QZ	$121.80	$234.00	$490.00
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $70.05 / $123.70 / $290.00	Professional		$70.05	$123.70	$290.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $154.05 / $275.00 / $420.00	Professional		$154.05	$275.00	$420.00
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 $407.00 / $3,375.00 / $4,100.00	Facility		$407.00	$3,375.00	$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 QK Low / Median / High Price $145.00 / $181.00 / $206.30	Professional	QK	$145.00	$181.00	$206.30
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