Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $63.59 / $488.00 / $672.00	Facility		$63.59	$488.00	$672.00
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $1,662.50 / $2,365.86 / $2,626.61	Facility	QZ	$1,662.50	$2,365.86	$2,626.61
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $496.00 / $582.64 / $679.28	Professional		$496.00	$582.64	$679.28
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $3,232.79 / $4,845.79 / $5,085.88	Facility		$3,232.79	$4,845.79	$5,085.88
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $352.00 / $416.00 / $602.00	Facility		$352.00	$416.00	$602.00
Providence Facility/Professional Facility Modifier Low / Median / High Price $651.20 / $3,232.79 / $5,085.88	Facility		$651.20	$3,232.79	$5,085.88
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