Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $261.39 / $315.00 / $420.00	Facility		$261.39	$315.00	$420.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $127.22 / $291.26 / $980.00	Professional	AA	$127.22	$291.26	$980.00
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $415.47 / $415.47 / $415.47	Professional	QX	$415.47	$415.47	$415.47
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $114.41 / $344.50 / $495.90	Professional	QZ	$114.41	$344.50	$495.90
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $310.00 / $364.15 / $424.55	Professional		$310.00	$364.15	$424.55
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $4,346.00 / $4,845.79 / $5,085.88	Facility		$4,346.00	$4,845.79	$5,085.88
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $220.00 / $260.00 / $376.25	Facility		$220.00	$260.00	$376.25
Providence Facility/Professional Facility Modifier Low / Median / High Price $407.00 / $3,232.79 / $5,085.88	Facility		$407.00	$3,232.79	$5,085.88
Providence Facility/Professional Facility Modifier QK Low / Median / High Price $203.50 / $203.50 / $203.50	Facility	QK	$203.50	$203.50	$203.50
Providence Facility/Professional Facility Modifier QX Low / Median / High Price $203.50 / $203.50 / $203.50	Facility	QX	$203.50	$203.50	$203.50
Providence Facility/Professional Facility Modifier QY Low / Median / High Price $203.50 / $203.50 / $203.50	Facility	QY	$203.50	$203.50	$203.50
Providence Facility/Professional Professional Modifier QX Low / Median / High Price $145.00 / $155.15 / $203.50	Professional	QX	$145.00	$155.15	$203.50
Providence Facility/Professional Professional Modifier QY Low / Median / High Price $145.00 / $155.15 / $203.50	Professional	QY	$145.00	$155.15	$203.50