Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $63.10 / $309.03 / $478.63	Facility		$63.10	$309.03	$478.63
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $354.81 / $537.03 / $831.76	Professional	AA	$354.81	$537.03	$831.76
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $239.88 / $316.23 / $457.09	Professional	QK	$239.88	$316.23	$457.09
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $234.42 / $309.03 / $436.52	Professional	QX	$234.42	$309.03	$436.52
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $245.47 / $295.12 / $398.11	Professional	QY	$245.47	$295.12	$398.11
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $436.52 / $549.54 / $691.83	Professional	QZ	$436.52	$549.54	$691.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $346.74 / $416.87	Professional		$309.03	$346.74	$416.87
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $229.09 / $4,466.84	Facility		$107.15	$229.09	$4,466.84
Moda Health Facility/Professional Professional Modifier AA Low / Median / High Price $407.38 / $660.69 / $977.24	Professional	AA	$407.38	$660.69	$977.24
Moda Health Facility/Professional Professional Modifier QK Low / Median / High Price $239.88 / $323.59 / $575.44	Professional	QK	$239.88	$323.59	$575.44
Moda Health Facility/Professional Professional Modifier QX Low / Median / High Price $190.55 / $309.03 / $512.86	Professional	QX	$190.55	$309.03	$512.86
Moda Health Facility/Professional Professional Modifier QY Low / Median / High Price $199.53 / $331.13 / $549.54	Professional	QY	$199.53	$331.13	$549.54
Moda Health Facility/Professional Professional Modifier QZ Low / Median / High Price $398.11 / $537.03 / $776.25	Professional	QZ	$398.11	$537.03	$776.25
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $234.42 / $257.04 / $363.08	Facility		$234.42	$257.04	$363.08
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
Providence Facility/Professional Professional Modifier QK Low / Median / High Price $151.36 / $151.36 / $151.36	Professional	QK	$151.36	$151.36	$151.36
Providence Facility/Professional Professional Modifier QX Low / Median / High Price $151.36 / $151.36 / $151.36	Professional	QX	$151.36	$151.36	$151.36
Providence Facility/Professional Professional Modifier QY Low / Median / High Price $151.36 / $151.36 / $151.36	Professional	QY	$151.36	$151.36	$151.36