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 $146.21 / $146.21 / $529.29	Professional	AA	$146.21	$146.21	$529.29
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 $212.50 / $260.00 / $345.00	Facility		$212.50	$260.00	$345.00
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
Regence BlueShield Facility/Professional Professional Modifier QX Low / Median / High Price $144.38 / $172.50 / $208.55	Professional	QX	$144.38	$172.50	$208.55
Regence BlueShield Facility/Professional Professional Modifier QY Low / Median / High Price $144.38 / $172.50 / $208.55	Professional	QY	$144.38	$172.50	$208.55