Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.00 / $41.00 / $1,528.00	Facility		$38.00	$41.00	$1,528.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $888.10 / $1,656.36 / $2,656.29	Professional	AA	$888.10	$1,656.36	$2,656.29
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $464.37 / $714.32 / $1,105.43	Professional	QK	$464.37	$714.32	$1,105.43
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $84.00 / $860.45 / $1,230.23	Professional	QX	$84.00	$860.45	$1,230.23
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $409.60 / $720.00 / $1,170.00	Professional	AA	$409.60	$720.00	$1,170.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $325.00 / $538.20 / $945.00	Professional	QK	$325.00	$538.20	$945.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $100.55 / $391.17 / $1,727.10	Professional	QX	$100.55	$391.17	$1,727.10
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $334.13 / $1,300.00 / $1,300.00	Professional	QZ	$334.13	$1,300.00	$1,300.00
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $102.55 / $181.09 / $424.56	Professional		$102.55	$181.09	$424.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $246.48 / $392.00 / $674.40	Professional		$246.48	$392.00	$674.40
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 $651.20 / $3,375.00 / $4,100.00	Facility		$651.20	$3,375.00	$4,100.00
Providence Facility/Professional Facility Modifier QK Low / Median / High Price $325.60 / $325.60 / $325.60	Facility	QK	$325.60	$325.60	$325.60
Providence Facility/Professional Facility Modifier QX Low / Median / High Price $325.60 / $325.60 / $325.60	Facility	QX	$325.60	$325.60	$325.60
Providence Facility/Professional Facility Modifier QY Low / Median / High Price $325.60 / $325.60 / $325.60	Facility	QY	$325.60	$325.60	$325.60
Providence Facility/Professional Professional Modifier QK Low / Median / High Price $232.00 / $288.00 / $330.08	Professional	QK	$232.00	$288.00	$330.08
Providence Facility/Professional Professional Modifier QX Low / Median / High Price $232.00 / $288.00 / $330.08	Professional	QX	$232.00	$288.00	$330.08