Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $30.20 / $354.81 / $436.52	Facility		$30.20	$354.81	$436.52
Aetna Facility/Professional Facility Modifier AA Low / Median / High Price $58.88 / $58.88 / $58.88	Facility	AA	$58.88	$58.88	$58.88
Aetna Facility/Professional Facility Modifier QK Low / Median / High Price $89.13 / $104.71 / $204.17	Facility	QK	$89.13	$104.71	$204.17
Aetna Facility/Professional Facility Modifier QX Low / Median / High Price $245.47 / $275.42 / $660.69	Facility	QX	$245.47	$275.42	$660.69
Aetna Facility/Professional Facility Modifier QY Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	QY	$100.00	$100.00	$100.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $144.54 / $758.58 / $1,412.54	Professional	AA	$144.54	$758.58	$1,412.54
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $89.13 / $309.03 / $537.03	Professional	QX	$89.13	$309.03	$537.03
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $208.93 / $316.23 / $588.84	Professional	QY	$208.93	$316.23	$588.84
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $138.04 / $562.34 / $1,148.15	Professional	QZ	$138.04	$562.34	$1,148.15
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $104.71 / $125.89 / $389.05	Professional	AA	$104.71	$125.89	$389.05
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $50.12 / $81.28 / $158.49	Professional	QX	$50.12	$81.28	$158.49
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $107.15 / $107.15 / $295.12	Professional	QY	$107.15	$107.15	$295.12
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $120.23 / $123.03 / $144.54	Professional	QZ	$120.23	$123.03	$144.54
Cigna Facility/Professional Facility Modifier Low / Median / High Price $61.66 / $61.66 / $61.66	Facility		$61.66	$61.66	$61.66
Cigna Facility/Professional Facility Modifier QK Low / Median / High Price $30.90 / $30.90 / $30.90	Facility	QK	$30.90	$30.90	$30.90
Cigna Facility/Professional Facility Modifier QX Low / Median / High Price $30.90 / $30.90 / $30.90	Facility	QX	$30.90	$30.90	$30.90
Cigna Facility/Professional Facility Modifier QY Low / Median / High Price $30.90 / $30.90 / $30.90	Facility	QY	$30.90	$30.90	$30.90
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $371.54 / $371.54 / $371.54	Facility		$371.54	$371.54	$371.54
Geisinger Facility/Professional Professional Modifier AA Low / Median / High Price $117.49 / $263.03 / $389.05	Professional	AA	$117.49	$263.03	$389.05
Geisinger Facility/Professional Professional Modifier QX Low / Median / High Price $117.49 / $263.03 / $389.05	Professional	QX	$117.49	$263.03	$389.05
Geisinger Facility/Professional Professional Modifier QY Low / Median / High Price $117.49 / $263.03 / $389.05	Professional	QY	$117.49	$263.03	$389.05
Geisinger Facility/Professional Professional Modifier QZ Low / Median / High Price $117.49 / $263.03 / $389.05	Professional	QZ	$117.49	$263.03	$389.05
Highmark BCBS Facility/Professional Professional Modifier AA Low / Median / High Price $323.59 / $416.87 / $602.56	Professional	AA	$323.59	$416.87	$602.56
Highmark BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $389.05 / $457.09 / $588.84	Professional	QX	$389.05	$457.09	$588.84
Highmark BCBS Facility/Professional Professional Modifier QY Low / Median / High Price $380.19 / $446.68 / $549.54	Professional	QY	$380.19	$446.68	$549.54
Highmark BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $309.03 / $380.19 / $478.63	Professional	QZ	$309.03	$380.19	$478.63
Johns Hopkins Employer Health Plan Facility/Professional Facility Modifier Low / Median / High Price $302.00 / $302.00 / $302.00	Facility		$302.00	$302.00	$302.00
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $47.86 / $323.59 / $416.87	Facility		$47.86	$323.59	$416.87
Martin's Point Facility/Professional Facility Modifier AA Low / Median / High Price $58.88 / $58.88 / $58.88	Facility	AA	$58.88	$58.88	$58.88
Martin's Point Facility/Professional Facility Modifier QK Low / Median / High Price $89.13 / $104.71 / $204.17	Facility	QK	$89.13	$104.71	$204.17
Martin's Point Facility/Professional Facility Modifier QX Low / Median / High Price $245.47 / $275.42 / $660.69	Facility	QX	$245.47	$275.42	$660.69
Martin's Point Facility/Professional Facility Modifier QY Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	QY	$100.00	$100.00	$100.00
Martin's Point Facility/Professional Professional Modifier AA Low / Median / High Price $147.91 / $870.96 / $1,412.54	Professional	AA	$147.91	$870.96	$1,412.54
Martin's Point Facility/Professional Professional Modifier QX Low / Median / High Price $69.18 / $316.23 / $562.34	Professional	QX	$69.18	$316.23	$562.34
Martin's Point Facility/Professional Professional Modifier QY Low / Median / High Price $223.87 / $338.84 / $588.84	Professional	QY	$223.87	$338.84	$588.84
Martin's Point Facility/Professional Professional Modifier QZ Low / Median / High Price $138.04 / $575.44 / $1,202.26	Professional	QZ	$138.04	$575.44	$1,202.26
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $3,388.44 / $4,265.80 / $6,760.83	Facility		$3,388.44	$4,265.80	$6,760.83