Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier QX Low / Median / High Price $1,218.34 / $1,218.34 / $5,632.74	Facility	QX	$1,218.34	$1,218.34	$5,632.74
Aetna Facility/Professional Facility Modifier QY Low / Median / High Price $439.96 / $439.96 / $2,034.05	Facility	QY	$439.96	$439.96	$2,034.05
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $913.00 / $1,540.00 / $2,800.00	Professional	AA	$913.00	$1,540.00	$2,800.00
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $169.47 / $424.20 / $656.12	Professional	QX	$169.47	$424.20	$656.12
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $132.32 / $328.05 / $627.59	Professional	QY	$132.32	$328.05	$627.59
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $653.46 / $653.46 / $653.46	Professional	QZ	$653.46	$653.46	$653.46
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $220.66 / $397.92 / $489.75	Professional	AA	$220.66	$397.92	$489.75
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $15.30 / $219.67 / $390.00	Professional	QX	$15.30	$219.67	$390.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $210.00 / $210.00 / $210.00	Professional	QY	$210.00	$210.00	$210.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $140.35 / $140.35 / $140.35	Professional	QZ	$140.35	$140.35	$140.35
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 / $360.00 / $360.00	Professional	QY	$180.00	$360.00	$360.00
Highmark BCBS Facility/Professional Professional Modifier AA Low / Median / High Price $500.67 / $942.00 / $2,050.90	Professional	AA	$500.67	$942.00	$2,050.90
Highmark BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $562.48 / $817.00 / $1,322.74	Professional	QX	$562.48	$817.00	$1,322.74
Highmark BCBS Facility/Professional Professional Modifier QY Low / Median / High Price $505.31 / $606.73 / $795.01	Professional	QY	$505.31	$606.73	$795.01
Highmark BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $480.39 / $613.01 / $828.16	Professional	QZ	$480.39	$613.01	$828.16
Martin's Point Facility/Professional Facility Modifier QX Low / Median / High Price $1,218.34 / $5,632.74 / $5,632.74	Facility	QX	$1,218.34	$5,632.74	$5,632.74
Martin's Point Facility/Professional Facility Modifier QY Low / Median / High Price $439.96 / $2,034.05 / $2,034.05	Facility	QY	$439.96	$2,034.05	$2,034.05
Martin's Point Facility/Professional Professional Modifier AA Low / Median / High Price $687.05 / $1,279.02 / $2,800.00	Professional	AA	$687.05	$1,279.02	$2,800.00
Martin's Point Facility/Professional Professional Modifier QX Low / Median / High Price $169.47 / $408.88 / $646.73	Professional	QX	$169.47	$408.88	$646.73
Martin's Point Facility/Professional Professional Modifier QY Low / Median / High Price $132.32 / $309.01 / $584.01	Professional	QY	$132.32	$309.01	$584.01
Martin's Point Facility/Professional Professional Modifier QZ Low / Median / High Price $653.46 / $653.46 / $653.46	Professional	QZ	$653.46	$653.46	$653.46
Priority Health Facility/Professional Professional Modifier QX Low / Median / High Price $180.00 / $180.00 / $180.00	Professional	QX	$180.00	$180.00	$180.00
Priority Health Facility/Professional Professional Modifier QY Low / Median / High Price $180.00 / $180.00 / $360.00	Professional	QY	$180.00	$180.00	$360.00
United Facility/Professional Professional Modifier QY Low / Median / High Price $90.00 / $90.00 / $90.00	Professional	QY	$90.00	$90.00	$90.00