Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.02 / $416.87 / $1,202.26	Facility		$38.02	$416.87	$1,202.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $50.12 / $851.14	Professional		$31.62	$50.12	$851.14
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $389.05 / $794.33 / $2,630.27	Professional	AA	$389.05	$794.33	$2,630.27
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $269.15 / $426.58 / $575.44	Professional	QX	$269.15	$426.58	$575.44
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $295.12 / $309.03 / $489.78	Professional	QY	$295.12	$309.03	$489.78
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $120.23 / $134.90 / $346.74	Professional	QZ	$120.23	$134.90	$346.74
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $123.03 / $426.58 / $457.09	Professional	AA	$123.03	$426.58	$457.09
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $229.09 / $229.09 / $229.09	Professional	QX	$229.09	$229.09	$229.09
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $363.08 / $363.08 / $389.05	Professional	QZ	$363.08	$363.08	$389.05
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $331.13 / $616.60	Professional		$245.47	$331.13	$616.60
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $302.00 / $489.78	Professional		$100.00	$302.00	$489.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $346.74 / $501.19	Professional		$229.09	$346.74	$501.19
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $138.04 / $323.59	Professional		$77.62	$138.04	$323.59
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $275.42 / $489.78	Professional		$134.90	$275.42	$489.78
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $104.71 / $104.71	Facility		$104.71	$104.71	$104.71
Lucent Health Facility/Professional Facility Modifier QK Low / Median / High Price $52.48 / $52.48 / $52.48	Facility	QK	$52.48	$52.48	$52.48
Lucent Health Facility/Professional Facility Modifier QX Low / Median / High Price $52.48 / $52.48 / $52.48	Facility	QX	$52.48	$52.48	$52.48
Lucent Health Facility/Professional Facility Modifier QY Low / Median / High Price $52.48 / $52.48 / $52.48	Facility	QY	$52.48	$52.48	$52.48
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,348.96 / $2,884.03 / $2,884.03	Professional		$1,348.96	$2,884.03	$2,884.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $91.20 / $91.20	Professional		$91.20	$91.20	$91.20
Providence Facility/Professional Facility Modifier Low / Median / High Price $2,089.30 / $4,073.80 / $5,623.41	Facility		$2,089.30	$4,073.80	$5,623.41
Providence Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $346.74 / $489.78	Professional		$218.78	$346.74	$489.78
Providence Facility/Professional Professional Modifier QX Low / Median / High Price $181.97 / $181.97 / $181.97	Professional	QX	$181.97	$181.97	$181.97
Providence Facility/Professional Professional Modifier QY Low / Median / High Price $181.97 / $181.97 / $181.97	Professional	QY	$181.97	$181.97	$181.97
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $489.78 / $489.78	Professional		$489.78	$489.78	$489.78
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $18.20 / $20.89 / $25.12	Professional		$18.20	$20.89	$25.12
United Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $52.48 / $83.18	Professional		$38.02	$52.48	$83.18