Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $33.81 / $480.00 / $876.00	Facility		$33.81	$480.00	$876.00
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $181.15 / $788.40 / $1,770.20	Professional	AA	$181.15	$788.40	$1,770.20
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $126.07 / $375.00 / $769.95	Professional	QK	$126.07	$375.00	$769.95
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $242.55 / $517.70 / $860.05	Professional	QX	$242.55	$517.70	$860.05
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $296.45 / $592.85 / $791.20	Professional	QY	$296.45	$592.85	$791.20
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $211.21 / $1,135.20 / $1,686.70	Professional	QZ	$211.21	$1,135.20	$1,686.70
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $127.98 / $200.90 / $992.97	Professional	AA	$127.98	$200.90	$992.97
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $178.50 / $392.00 / $460.00	Professional	QK	$178.50	$392.00	$460.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $70.20 / $448.00 / $992.97	Professional	QX	$70.20	$448.00	$992.97
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $137.11 / $137.11 / $504.00	Professional	QY	$137.11	$137.11	$504.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $120.54 / $120.54 / $160.08	Professional	QZ	$120.54	$120.54	$160.08
Cigna Facility/Professional Professional Modifier QK Low / Median / High Price $180.00 / $180.00 / $180.00	Professional	QK	$180.00	$180.00	$180.00
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 / $180.00 / $180.00	Professional	QY	$180.00	$180.00	$180.00
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $450.00 / $450.00 / $450.00	Facility		$450.00	$450.00	$450.00
Highmark BCBS Facility/Professional Professional Modifier AA Low / Median / High Price $254.24 / $620.40 / $830.00	Professional	AA	$254.24	$620.40	$830.00
Highmark BCBS Facility/Professional Professional Modifier QK Low / Median / High Price $247.41 / $707.40 / $878.64	Professional	QK	$247.41	$707.40	$878.64
Highmark BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $257.42 / $685.33 / $859.20	Professional	QX	$257.42	$685.33	$859.20
Highmark BCBS Facility/Professional Professional Modifier QY Low / Median / High Price $186.36 / $467.20 / $735.00	Professional	QY	$186.36	$467.20	$735.00
Highmark BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $233.00 / $508.40 / $627.79	Professional	QZ	$233.00	$508.40	$627.79
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $555.00 / $597.00 / $74,999.25	Facility		$555.00	$597.00	$74,999.25
MVP Health Care Facility/Professional Professional Modifier QK Low / Median / High Price $180.00 / $180.00 / $180.00	Professional	QK	$180.00	$180.00	$180.00
MVP Health Care Facility/Professional Professional Modifier QX Low / Median / High Price $180.00 / $180.00 / $180.00	Professional	QX	$180.00	$180.00	$180.00
MVP Health Care Facility/Professional Professional Modifier QY Low / Median / High Price $180.00 / $180.00 / $180.00	Professional	QY	$180.00	$180.00	$180.00
United Facility/Professional Professional Modifier AA Low / Median / High Price $365.00 / $365.00 / $1,445.60	Professional	AA	$365.00	$365.00	$1,445.60
Univera Facility/Professional Facility Modifier Low / Median / High Price $220.00 / $220.00 / $220.00	Facility		$220.00	$220.00	$220.00