Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier QK Low / Median / High Price $302.00 / $302.00 / $331.13	Facility	QK	$302.00	$302.00	$331.13
Aetna Facility/Professional Facility Modifier QX Low / Median / High Price $851.14 / $912.01 / $1,513.56	Facility	QX	$851.14	$912.01	$1,513.56
Aetna Facility/Professional Facility Modifier QY Low / Median / High Price $1,479.11 / $1,479.11 / $1,479.11	Facility	QY	$1,479.11	$1,479.11	$1,479.11
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $645.65 / $1,513.56 / $2,511.89	Professional	AA	$645.65	$1,513.56	$2,511.89
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $588.84 / $1,258.93 / $2,290.87	Professional	QZ	$588.84	$1,258.93	$2,290.87
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $169.82 / $416.87 / $912.01	Professional	AA	$169.82	$416.87	$912.01
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $218.78 / $245.47 / $645.65	Professional	QZ	$218.78	$245.47	$645.65
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
Geisinger Facility/Professional Professional Modifier AA Low / Median / High Price $141.25 / $316.23 / $467.74	Professional	AA	$141.25	$316.23	$467.74
Geisinger Facility/Professional Professional Modifier QZ Low / Median / High Price $141.25 / $316.23 / $467.74	Professional	QZ	$141.25	$316.23	$467.74
Highmark BCBS Facility/Professional Professional Modifier AA Low / Median / High Price $537.03 / $977.24 / $1,778.28	Professional	AA	$537.03	$977.24	$1,778.28
Highmark BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $416.87 / $537.03 / $724.44	Professional	QZ	$416.87	$537.03	$724.44
Martin's Point Facility/Professional Facility Modifier QK Low / Median / High Price $302.00 / $302.00 / $331.13	Facility	QK	$302.00	$302.00	$331.13
Martin's Point Facility/Professional Facility Modifier QX Low / Median / High Price $851.14 / $912.01 / $1,513.56	Facility	QX	$851.14	$912.01	$1,513.56
Martin's Point Facility/Professional Facility Modifier QY Low / Median / High Price $1,479.11 / $1,479.11 / $1,479.11	Facility	QY	$1,479.11	$1,479.11	$1,479.11
Martin's Point Facility/Professional Professional Modifier AA Low / Median / High Price $645.65 / $1,479.11 / $2,570.40	Professional	AA	$645.65	$1,479.11	$2,570.40
Martin's Point Facility/Professional Professional Modifier QZ Low / Median / High Price $512.86 / $1,258.93 / $2,290.87	Professional	QZ	$512.86	$1,258.93	$2,290.87