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 Facility Modifier QZ Low / Median / High Price $874.65 / $874.65 / $874.65	Facility	QZ	$874.65	$874.65	$874.65
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $376.03 / $840.00 / $1,120.00	Professional	AA	$376.03	$840.00	$1,120.00
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $388.68 / $500.76 / $641.41	Professional	QK	$388.68	$500.76	$641.41
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $403.36 / $520.02 / $628.19	Professional	QX	$403.36	$520.02	$628.19
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $351.66 / $498.64 / $611.87	Professional	QY	$351.66	$498.64	$611.87
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $236.50 / $398.52 / $611.10	Professional	QZ	$236.50	$398.52	$611.10
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $306.00 / $476.00 / $680.00	Professional	AA	$306.00	$476.00	$680.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $51.83 / $275.83 / $291.55	Professional	QK	$51.83	$275.83	$291.55
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $10.75 / $291.55 / $752.00	Professional	QX	$10.75	$291.55	$752.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $266.22 / $266.22 / $455.00	Professional	QY	$266.22	$266.22	$455.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $101.50 / $234.00 / $444.00	Professional	QZ	$101.50	$234.00	$444.00
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $56.04 / $98.96 / $232.00	Professional		$56.04	$98.96	$232.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $123.24 / $275.00 / $420.00	Professional		$123.24	$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