Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $63.10 / $371.54 / $575.44	Facility		$63.10	$371.54	$575.44
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $954.99 / $954.99 / $954.99	Facility	QZ	$954.99	$954.99	$954.99
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $398.11 / $562.34 / $977.24	Professional	AA	$398.11	$562.34	$977.24
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $239.88 / $346.74 / $537.03	Professional	QK	$239.88	$346.74	$537.03
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $208.93 / $331.13 / $537.03	Professional	QX	$208.93	$331.13	$537.03
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $269.15 / $331.13 / $457.09	Professional	QY	$269.15	$331.13	$457.09
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $363.08 / $575.44 / $724.44	Professional	QZ	$363.08	$575.44	$724.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $416.87 / $501.19	Professional		$371.54	$416.87	$501.19
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $275.42 / $4,466.84	Facility		$107.15	$275.42	$4,466.84
Moda Health Facility/Professional Facility Modifier QZ Low / Median / High Price $954.99 / $954.99 / $954.99	Facility	QZ	$954.99	$954.99	$954.99
Moda Health Facility/Professional Professional Modifier AA Low / Median / High Price $478.63 / $724.44 / $1,096.48	Professional	AA	$478.63	$724.44	$1,096.48
Moda Health Facility/Professional Professional Modifier QK Low / Median / High Price $158.49 / $338.84 / $588.84	Professional	QK	$158.49	$338.84	$588.84
Moda Health Facility/Professional Professional Modifier QX Low / Median / High Price $154.88 / $316.23 / $588.84	Professional	QX	$154.88	$316.23	$588.84
Moda Health Facility/Professional Professional Modifier QY Low / Median / High Price $257.04 / $316.23 / $562.34	Professional	QY	$257.04	$316.23	$562.34
Moda Health Facility/Professional Professional Modifier QZ Low / Median / High Price $363.08 / $575.44 / $1,000.00	Professional	QZ	$363.08	$575.44	$1,000.00
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $281.84 / $309.03 / $436.52	Facility		$281.84	$309.03	$436.52
Providence Facility/Professional Facility Modifier Low / Median / High Price $67.61 / $4,466.84 / $6,309.57	Facility		$67.61	$4,466.84	$6,309.57
Providence Facility/Professional Facility Modifier QK Low / Median / High Price $30.90 / $30.90 / $30.90	Facility	QK	$30.90	$30.90	$30.90
Providence Facility/Professional Facility Modifier QX Low / Median / High Price $30.90 / $30.90 / $30.90	Facility	QX	$30.90	$30.90	$30.90
Providence Facility/Professional Facility Modifier QY Low / Median / High Price $30.90 / $30.90 / $30.90	Facility	QY	$30.90	$30.90	$30.90
Providence Facility/Professional Professional Modifier QK Low / Median / High Price $181.97 / $181.97 / $181.97	Professional	QK	$181.97	$181.97	$181.97
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