Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $40.74 / $851.14 / $1,000.00	Facility		$40.74	$851.14	$1,000.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $363.08 / $831.76 / $1,258.93	Professional	AA	$363.08	$831.76	$1,258.93
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $120.23 / $354.81 / $660.69	Professional	QK	$120.23	$354.81	$660.69
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $223.87 / $371.54 / $660.69	Professional	QX	$223.87	$371.54	$660.69
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $239.88 / $323.59 / $630.96	Professional	QY	$239.88	$323.59	$630.96
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $199.53 / $426.58 / $1,288.25	Professional	QZ	$199.53	$426.58	$1,288.25
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $380.19 / $562.34 / $831.76	Professional	AA	$380.19	$562.34	$831.76
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $89.13 / $229.09 / $398.11	Professional	QK	$89.13	$229.09	$398.11
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $107.15 / $257.04 / $398.11	Professional	QX	$107.15	$257.04	$398.11
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $331.13 / $331.13 / $549.54	Professional	QY	$331.13	$331.13	$549.54
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $128.82 / $309.03 / $676.08	Professional	QZ	$128.82	$309.03	$676.08
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $123.03 / $288.40	Professional		$70.79	$123.03	$288.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $251.19 / $398.11	Professional		$112.20	$251.19	$398.11
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
Providence Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $3,630.78 / $5,623.41	Facility		$87.10	$3,630.78	$5,623.41
Providence Facility/Professional Professional Modifier QK Low / Median / High Price $151.36 / $151.36 / $151.36	Professional	QK	$151.36	$151.36	$151.36
Providence Facility/Professional Professional Modifier QX Low / Median / High Price $151.36 / $151.36 / $151.36	Professional	QX	$151.36	$151.36	$151.36
Providence Facility/Professional Professional Modifier QY Low / Median / High Price $151.36 / $151.36 / $151.36	Professional	QY	$151.36	$151.36	$151.36