Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $30.00 / $357.90 / $432.10	Facility		$30.00	$357.90	$432.10
Aetna Facility/Professional Facility Modifier AA Low / Median / High Price $59.54 / $59.54 / $59.54	Facility	AA	$59.54	$59.54	$59.54
Aetna Facility/Professional Facility Modifier QK Low / Median / High Price $89.86 / $105.65 / $135.00	Facility	QK	$89.86	$105.65	$135.00
Aetna Facility/Professional Facility Modifier QX Low / Median / High Price $247.32 / $276.48 / $616.97	Facility	QX	$247.32	$276.48	$616.97
Aetna Facility/Professional Facility Modifier QY Low / Median / High Price $99.78 / $99.78 / $99.78	Facility	QY	$99.78	$99.78	$99.78
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $115.83 / $574.73 / $980.00	Professional	AA	$115.83	$574.73	$980.00
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $198.85 / $295.06 / $381.11	Professional	QX	$198.85	$295.06	$381.11
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $206.08 / $249.75 / $402.14	Professional	QY	$206.08	$249.75	$402.14
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $120.01 / $533.66 / $630.23	Professional	QZ	$120.01	$533.66	$630.23
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $105.55 / $174.74 / $480.00	Professional	AA	$105.55	$174.74	$480.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $12.48 / $139.33 / $210.00	Professional	QX	$12.48	$139.33	$210.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $100.25 / $147.77 / $490.00	Professional	QZ	$100.25	$147.77	$490.00
Cigna Facility/Professional Professional Modifier QX Low / Median / High Price $150.00 / $150.00 / $150.00	Professional	QX	$150.00	$150.00	$150.00
Cigna Facility/Professional Professional Modifier QY Low / Median / High Price $150.00 / $300.00 / $300.00	Professional	QY	$150.00	$300.00	$300.00
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $375.00 / $375.00 / $375.00	Facility		$375.00	$375.00	$375.00
Highmark BCBS Facility/Professional Professional Modifier AA Low / Median / High Price $301.26 / $405.83 / $581.88	Professional	AA	$301.26	$405.83	$581.88
Highmark BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $383.41 / $457.97 / $602.89	Professional	QX	$383.41	$457.97	$602.89
Highmark BCBS Facility/Professional Professional Modifier QY Low / Median / High Price $396.64 / $461.40 / $563.27	Professional	QY	$396.64	$461.40	$563.27
Highmark BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $318.01 / $378.13 / $443.18	Professional	QZ	$318.01	$378.13	$443.18
Johns Hopkins Employer Health Plan Facility/Professional Facility Modifier Low / Median / High Price $300.00 / $300.00 / $300.00	Facility		$300.00	$300.00	$300.00
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $48.00 / $325.00 / $400.70	Facility		$48.00	$325.00	$400.70
Martin's Point Facility/Professional Facility Modifier AA Low / Median / High Price $59.54 / $59.54 / $59.54	Facility	AA	$59.54	$59.54	$59.54
Martin's Point Facility/Professional Facility Modifier QK Low / Median / High Price $89.86 / $105.65 / $135.00	Facility	QK	$89.86	$105.65	$135.00
Martin's Point Facility/Professional Facility Modifier QX Low / Median / High Price $247.32 / $519.54 / $616.97	Facility	QX	$247.32	$519.54	$616.97
Martin's Point Facility/Professional Facility Modifier QY Low / Median / High Price $99.78 / $99.78 / $99.78	Facility	QY	$99.78	$99.78	$99.78
Martin's Point Facility/Professional Professional Modifier AA Low / Median / High Price $127.56 / $582.16 / $980.00	Professional	AA	$127.56	$582.16	$980.00
Martin's Point Facility/Professional Professional Modifier QX Low / Median / High Price $107.03 / $287.85 / $380.00	Professional	QX	$107.03	$287.85	$380.00
Martin's Point Facility/Professional Professional Modifier QY Low / Median / High Price $206.08 / $235.92 / $402.14	Professional	QY	$206.08	$235.92	$402.14
Martin's Point Facility/Professional Professional Modifier QZ Low / Median / High Price $120.01 / $567.55 / $630.23	Professional	QZ	$120.01	$567.55	$630.23
Priority Health Facility/Professional Professional Modifier QX Low / Median / High Price $150.00 / $150.00 / $150.00	Professional	QX	$150.00	$150.00	$150.00
Priority Health Facility/Professional Professional Modifier QY Low / Median / High Price $150.00 / $150.00 / $300.00	Professional	QY	$150.00	$150.00	$300.00