Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $63.59 / $305.00 / $420.00	Facility		$63.59	$305.00	$420.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $147.61 / $840.00 / $1,400.00	Professional	AA	$147.61	$840.00	$1,400.00
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $722.02 / $722.02 / $722.02	Professional	QX	$722.02	$722.02	$722.02
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $77.38 / $77.38 / $77.38	Professional	QY	$77.38	$77.38	$77.38
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $435.00 / $495.90 / $536.00	Professional	QZ	$435.00	$495.90	$536.00
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 QK Low / Median / High Price $142.50 / $152.50 / $203.50	Professional	QK	$142.50	$152.50	$203.50
Providence Facility/Professional Professional Modifier QX Low / Median / High Price $142.50 / $152.50 / $203.50	Professional	QX	$142.50	$152.50	$203.50
Providence Facility/Professional Professional Modifier QY Low / Median / High Price $142.50 / $152.50 / $203.50	Professional	QY	$142.50	$152.50	$203.50