Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $172.06 / $830.00 / $1,540.00	Professional	AA	$172.06	$830.00	$1,540.00
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $68.81 / $68.81 / $68.81	Professional	QX	$68.81	$68.81	$68.81
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $649.64 / $649.64 / $649.64	Professional	QY	$649.64	$649.64	$649.64
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $488.48 / $585.95 / $837.20	Professional	QZ	$488.48	$585.95	$837.20
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $267.14 / $576.00 / $721.44	Professional	AA	$267.14	$576.00	$721.44
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $124.39 / $187.78 / $657.80	Professional	QK	$124.39	$187.78	$657.80
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $77.56 / $159.40 / $187.78	Professional	QX	$77.56	$159.40	$187.78
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $478.40 / $478.40 / $478.40	Professional	QY	$478.40	$478.40	$478.40
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $155.12 / $232.68 / $455.00	Professional	QZ	$155.12	$232.68	$455.00
Asuris Northwest Health Facility/Professional Professional Modifier AA Low / Median / High Price $1,102.40 / $1,102.40 / $1,102.40	Professional	AA	$1,102.40	$1,102.40	$1,102.40
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