Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $309.03 / $380.19 / $575.44	Facility		$309.03	$380.19	$575.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $44.67 / $524.81	Professional		$31.62	$44.67	$524.81
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $389.05 / $389.05 / $537.03	Professional	AA	$389.05	$389.05	$537.03
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $295.12 / $489.78 / $549.54	Professional	QX	$295.12	$489.78	$549.54
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $295.12 / $309.03 / $489.78	Professional	QY	$295.12	$309.03	$489.78
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $436.52 / $436.52 / $436.52	Professional	QZ	$436.52	$436.52	$436.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $309.03 / $426.58	Professional		$251.19	$309.03	$426.58
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 $275.42 / $275.42 / $4,897.79	Facility		$275.42	$275.42	$4,897.79
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $338.84 / $549.54	Professional		$44.67	$338.84	$549.54
Moda Health Facility/Professional Professional Modifier AA Low / Median / High Price $389.05 / $389.05 / $537.03	Professional	AA	$389.05	$389.05	$537.03
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $257.04 / $309.03 / $416.87	Facility		$257.04	$309.03	$416.87
Providence Facility/Professional Facility Modifier Low / Median / High Price $549.54 / $4,466.84 / $6,309.57	Facility		$549.54	$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 Low / Median / High Price $79.43 / $323.59 / $446.68	Professional		$79.43	$323.59	$446.68
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
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $389.05 / $501.19	Professional		$346.74	$389.05	$501.19
Regence BlueShield Facility/Professional Professional Modifier QX Low / Median / High Price $173.78 / $194.98 / $251.19	Professional	QX	$173.78	$194.98	$251.19
Regence BlueShield Facility/Professional Professional Modifier QY Low / Median / High Price $173.78 / $194.98 / $251.19	Professional	QY	$173.78	$194.98	$251.19
United Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $64.57 / $83.18	Professional		$48.98	$64.57	$83.18