Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.00 / $41.00 / $1,146.00	Facility		$38.00	$41.00	$1,146.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $31.82 / $41.00 / $773.64	Professional		$31.82	$41.00	$773.64
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $387.60 / $865.55 / $1,271.16	Professional	AA	$387.60	$865.55	$1,271.16
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $771.19 / $771.19 / $771.19	Professional	QX	$771.19	$771.19	$771.19
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $102.20 / $145.11 / $455.00	Professional	AA	$102.20	$145.11	$455.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $227.50 / $735.00 / $735.00	Professional	QX	$227.50	$735.00	$735.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $140.77 / $273.00 / $828.00	Professional	QZ	$140.77	$273.00	$828.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $249.96 / $343.80 / $572.16	Professional		$249.96	$343.80	$572.16
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $274.86 / $413.47	Professional		$100.00	$274.86	$413.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $237.50 / $350.00 / $523.65	Professional		$237.50	$350.00	$523.65
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $77.34 / $136.56 / $320.16	Professional		$77.34	$136.56	$320.16
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $182.43 / $294.00 / $504.00	Professional		$182.43	$294.00	$504.00
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
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,351.68 / $1,351.68 / $2,880.00	Professional		$1,351.68	$1,351.68	$2,880.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $92.15 / $350.00 / $400.00	Professional		$92.15	$350.00	$400.00
Providence Facility/Professional Facility Modifier Low / Median / High Price $543.90 / $3,800.00 / $4,100.00	Facility		$543.90	$3,800.00	$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 Low / Median / High Price $250.00 / $360.00 / $499.50	Professional		$250.00	$360.00	$499.50
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
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $485.00 / $485.00 / $485.00	Professional		$485.00	$485.00	$485.00
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $18.05 / $21.02 / $28.23	Professional		$18.05	$21.02	$28.23
United Facility/Professional Professional Modifier Low / Median / High Price $37.93 / $50.00 / $83.82	Professional		$37.93	$50.00	$83.82