Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $31.50 / $418.95 / $1,154.16	Facility		$31.50	$418.95	$1,154.16
Aetna Facility/Professional Facility Modifier QK Low / Median / High Price $95.26 / $146.58 / $205.43	Facility	QK	$95.26	$146.58	$205.43
Aetna Facility/Professional Facility Modifier QX Low / Median / High Price $263.81 / $445.18 / $942.73	Facility	QX	$263.81	$445.18	$942.73
Aetna Facility/Professional Facility Modifier QY Low / Median / High Price $190.53 / $197.22 / $340.43	Facility	QY	$190.53	$197.22	$340.43
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $213.20 / $688.50 / $1,400.00	Professional	AA	$213.20	$688.50	$1,400.00
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $112.99 / $295.24 / $408.10	Professional	QK	$112.99	$295.24	$408.10
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $140.00 / $296.80 / $404.00	Professional	QX	$140.00	$296.80	$404.00
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $209.00 / $277.75 / $376.30	Professional	QY	$209.00	$277.75	$376.30
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $445.36 / $565.60 / $737.30	Professional	QZ	$445.36	$565.60	$737.30
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $147.77 / $183.66 / $287.57	Professional	AA	$147.77	$183.66	$287.57
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $84.25 / $121.91 / $270.00	Professional	QK	$84.25	$121.91	$270.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $15.30 / $136.30 / $300.00	Professional	QX	$15.30	$136.30	$300.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $69.90 / $122.44 / $180.00	Professional	QY	$69.90	$122.44	$180.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $119.82 / $214.27 / $420.00	Professional	QZ	$119.82	$214.27	$420.00
Cigna Facility/Professional Professional Modifier QK Low / Median / High Price $150.00 / $150.00 / $150.00	Professional	QK	$150.00	$150.00	$150.00
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 Facility Modifier QZ Low / Median / High Price $61.92 / $61.92 / $61.92	Facility	QZ	$61.92	$61.92	$61.92
Highmark BCBS Facility/Professional Professional Modifier AA Low / Median / High Price $374.14 / $513.07 / $966.66	Professional	AA	$374.14	$513.07	$966.66
Highmark BCBS Facility/Professional Professional Modifier QK Low / Median / High Price $368.55 / $470.39 / $632.63	Professional	QK	$368.55	$470.39	$632.63
Highmark BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $367.89 / $466.75 / $617.74	Professional	QX	$367.89	$466.75	$617.74
Highmark BCBS Facility/Professional Professional Modifier QY Low / Median / High Price $361.99 / $469.12 / $694.99	Professional	QY	$361.99	$469.12	$694.99
Highmark BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $285.30 / $371.99 / $470.77	Professional	QZ	$285.30	$371.99	$470.77
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 $199.08 / $419.60 / $1,154.16	Facility		$199.08	$419.60	$1,154.16
Martin's Point Facility/Professional Facility Modifier QK Low / Median / High Price $95.26 / $146.58 / $205.43	Facility	QK	$95.26	$146.58	$205.43
Martin's Point Facility/Professional Facility Modifier QX Low / Median / High Price $263.81 / $445.18 / $942.73	Facility	QX	$263.81	$445.18	$942.73
Martin's Point Facility/Professional Facility Modifier QY Low / Median / High Price $190.53 / $197.22 / $340.43	Facility	QY	$190.53	$197.22	$340.43
Martin's Point Facility/Professional Professional Modifier AA Low / Median / High Price $213.20 / $653.98 / $1,260.00	Professional	AA	$213.20	$653.98	$1,260.00
Martin's Point Facility/Professional Professional Modifier QK Low / Median / High Price $114.48 / $290.95 / $396.07	Professional	QK	$114.48	$290.95	$396.07
Martin's Point Facility/Professional Professional Modifier QX Low / Median / High Price $135.00 / $290.14 / $396.07	Professional	QX	$135.00	$290.14	$396.07
Martin's Point Facility/Professional Professional Modifier QY Low / Median / High Price $207.40 / $271.16 / $376.30	Professional	QY	$207.40	$271.16	$376.30
Martin's Point Facility/Professional Professional Modifier QZ Low / Median / High Price $431.86 / $561.32 / $736.88	Professional	QZ	$431.86	$561.32	$736.88
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,732.17 / $1,940.00 / $2,370.54	Facility		$1,732.17	$1,940.00	$2,370.54
Priority Health Facility/Professional Professional Modifier QK Low / Median / High Price $150.00 / $150.00 / $150.00	Professional	QK	$150.00	$150.00	$150.00
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