Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier QK Low / Median / High Price $251.19 / $346.74 / $389.05	Facility	QK	$251.19	$346.74	$389.05
Aetna Facility/Professional Facility Modifier QX Low / Median / High Price $691.83 / $691.83 / $1,230.27	Facility	QX	$691.83	$691.83	$1,230.27
Aetna Facility/Professional Facility Modifier QY Low / Median / High Price $177.83 / $177.83 / $177.83	Facility	QY	$177.83	$177.83	$177.83
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $645.65 / $1,380.38 / $2,041.74	Professional	AA	$645.65	$1,380.38	$2,041.74
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $562.34 / $1,380.38 / $1,737.80	Professional	QZ	$562.34	$1,380.38	$1,737.80
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $181.97 / $346.74 / $724.44	Professional	AA	$181.97	$346.74	$724.44
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $162.18 / $162.18 / $234.42	Professional	QZ	$162.18	$162.18	$234.42
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 $117.49 / $263.03 / $389.05	Professional	AA	$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 $501.19 / $794.33 / $1,778.28	Professional	AA	$501.19	$794.33	$1,778.28
Highmark BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $478.63 / $676.08 / $758.58	Professional	QZ	$478.63	$676.08	$758.58
Martin's Point Facility/Professional Facility Modifier QK Low / Median / High Price $251.19 / $346.74 / $389.05	Facility	QK	$251.19	$346.74	$389.05
Martin's Point Facility/Professional Facility Modifier QX Low / Median / High Price $691.83 / $691.83 / $1,230.27	Facility	QX	$691.83	$691.83	$1,230.27
Martin's Point Facility/Professional Facility Modifier QY Low / Median / High Price $177.83 / $177.83 / $177.83	Facility	QY	$177.83	$177.83	$177.83
Martin's Point Facility/Professional Professional Modifier AA Low / Median / High Price $616.60 / $1,348.96 / $2,238.72	Professional	AA	$616.60	$1,348.96	$2,238.72
Martin's Point Facility/Professional Professional Modifier QZ Low / Median / High Price $562.34 / $1,380.38 / $1,737.80	Professional	QZ	$562.34	$1,380.38	$1,737.80