Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $63.59 / $366.00 / $504.00	Facility		$63.59	$366.00	$504.00
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $950.00 / $950.00 / $950.00	Facility	QZ	$950.00	$950.00	$950.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $130.60 / $675.12 / $1,540.00	Professional	AA	$130.60	$675.12	$1,540.00
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $67.88 / $138.32 / $182.91	Professional	QX	$67.88	$138.32	$182.91
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $126.13 / $359.10 / $717.60	Professional	QZ	$126.13	$359.10	$717.60
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $372.00 / $436.98 / $509.46	Professional		$372.00	$436.98	$509.46
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 $264.00 / $312.00 / $451.50	Facility		$264.00	$312.00	$451.50
Providence Facility/Professional Facility Modifier Low / Median / High Price $488.40 / $3,232.79 / $5,085.88	Facility		$488.40	$3,232.79	$5,085.88
Providence Facility/Professional Facility Modifier QK Low / Median / High Price $244.20 / $244.20 / $244.20	Facility	QK	$244.20	$244.20	$244.20
Providence Facility/Professional Facility Modifier QX Low / Median / High Price $244.20 / $244.20 / $244.20	Facility	QX	$244.20	$244.20	$244.20
Providence Facility/Professional Facility Modifier QY Low / Median / High Price $244.20 / $244.20 / $244.20	Facility	QY	$244.20	$244.20	$244.20
Providence Facility/Professional Professional Modifier QK Low / Median / High Price $171.00 / $186.18 / $244.20	Professional	QK	$171.00	$186.18	$244.20
Providence Facility/Professional Professional Modifier QX Low / Median / High Price $171.00 / $186.18 / $244.20	Professional	QX	$171.00	$186.18	$244.20
Providence Facility/Professional Professional Modifier QY Low / Median / High Price $171.00 / $186.18 / $244.20	Professional	QY	$171.00	$186.18	$244.20
United Facility/Professional Professional Modifier AA Low / Median / High Price $1,445.60 / $1,445.60 / $1,445.60	Professional	AA	$1,445.60	$1,445.60	$1,445.60
United Facility/Professional Professional Modifier QX Low / Median / High Price $80.00 / $80.00 / $80.00	Professional	QX	$80.00	$80.00	$80.00