Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $50.50 / $412.80 / $553.20	Facility		$50.50	$412.80	$553.20
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $136.61 / $838.30 / $1,820.00	Professional	AA	$136.61	$838.30	$1,820.00
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $65.73 / $138.32 / $138.32	Professional	QX	$65.73	$138.32	$138.32
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $126.13 / $412.80 / $717.60	Professional	QZ	$126.13	$412.80	$717.60
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $228.98 / $504.00 / $720.00	Professional	AA	$228.98	$504.00	$720.00
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $124.39 / $206.55 / $386.16	Professional	QK	$124.39	$206.55	$386.16
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $124.39 / $150.22 / $216.00	Professional	QX	$124.39	$150.22	$216.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $119.55 / $119.55 / $177.71	Professional	QY	$119.55	$119.55	$177.71
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $142.10 / $200.97 / $498.00	Professional	QZ	$142.10	$200.97	$498.00
Asuris Northwest Health Facility/Professional Professional Modifier AA Low / Median / High Price $216.11 / $216.11 / $993.54	Professional	AA	$216.11	$216.11	$993.54
Cigna Facility/Professional Professional Modifier QK Low / Median / High Price $180.00 / $180.00 / $180.00	Professional	QK	$180.00	$180.00	$180.00
Cigna Facility/Professional Professional Modifier QX Low / Median / High Price $180.00 / $180.00 / $180.00	Professional	QX	$180.00	$180.00	$180.00
Cigna Facility/Professional Professional Modifier QY Low / Median / High Price $180.00 / $180.00 / $180.00	Professional	QY	$180.00	$180.00	$180.00
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $150.00 / $250.00 / $410.00	Facility		$150.00	$250.00	$410.00
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $267.00 / $312.00 / $451.50	Facility		$267.00	$312.00	$451.50
United Facility/Professional Professional Modifier AA Low / Median / High Price $75.00 / $640.00 / $1,445.60	Professional	AA	$75.00	$640.00	$1,445.60
United Facility/Professional Professional Modifier QX Low / Median / High Price $80.00 / $85.00 / $85.00	Professional	QX	$80.00	$85.00	$85.00