Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.00 / $41.00 / $1,814.06	Facility		$38.00	$41.00	$1,814.06
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