Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $501.19 / $776.25	Facility		$107.15	$501.19	$776.25
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $1,258.93 / $2,344.23 / $2,630.27	Facility	QZ	$1,258.93	$2,344.23	$2,630.27
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $562.34 / $676.08	Professional		$501.19	$562.34	$676.08
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $371.54 / $371.54 / $4,897.79	Facility		$371.54	$371.54	$4,897.79
Moda Health Facility/Professional Facility Modifier QZ Low / Median / High Price $1,258.93 / $2,344.23 / $2,630.27	Facility	QZ	$1,258.93	$2,344.23	$2,630.27
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $371.54 / $416.87 / $575.44	Facility		$371.54	$416.87	$575.44
Providence Facility/Professional Facility Modifier Low / Median / High Price $67.61 / $4,466.84 / $6,309.57	Facility		$67.61	$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