Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $30.00 / $428.95 / $988.20	Facility		$30.00	$428.95	$988.20
Aetna Facility/Professional Facility Modifier QK Low / Median / High Price $154.75 / $211.30 / $228.66	Facility	QK	$154.75	$211.30	$228.66
Aetna Facility/Professional Facility Modifier QX Low / Median / High Price $276.32 / $585.14 / $682.67	Facility	QX	$276.32	$585.14	$682.67
Aetna Facility/Professional Facility Modifier QY Low / Median / High Price $82.17 / $99.78 / $187.62	Facility	QY	$82.17	$99.78	$187.62
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $225.50 / $567.00 / $1,120.00	Professional	AA	$225.50	$567.00	$1,120.00
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $93.93 / $265.64 / $345.41	Professional	QK	$93.93	$265.64	$345.41
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $97.05 / $262.27 / $344.00	Professional	QX	$97.05	$262.27	$344.00
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $81.77 / $239.98 / $297.95	Professional	QY	$81.77	$239.98	$297.95
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $431.77 / $541.82 / $647.79	Professional	QZ	$431.77	$541.82	$647.79
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $149.78 / $159.76 / $208.99	Professional	AA	$149.78	$159.76	$208.99
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $70.20 / $97.52 / $240.00	Professional	QK	$70.20	$97.52	$240.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $15.30 / $90.27 / $240.00	Professional	QX	$15.30	$90.27	$240.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $76.52 / $81.26 / $107.13	Professional	QY	$76.52	$81.26	$107.13
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $99.85 / $199.70 / $424.00	Professional	QZ	$99.85	$199.70	$424.00
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 $300.00 / $300.00 / $300.00	Facility		$300.00	$300.00	$300.00
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 $285.64 / $362.98 / $605.04	Professional	AA	$285.64	$362.98	$605.04
Highmark BCBS Facility/Professional Professional Modifier QK Low / Median / High Price $273.42 / $365.32 / $487.16	Professional	QK	$273.42	$365.32	$487.16
Highmark BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $286.91 / $363.47 / $468.92	Professional	QX	$286.91	$363.47	$468.92
Highmark BCBS Facility/Professional Professional Modifier QY Low / Median / High Price $310.27 / $358.76 / $466.39	Professional	QY	$310.27	$358.76	$466.39
Highmark BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $223.93 / $297.14 / $380.77	Professional	QZ	$223.93	$297.14	$380.77
Johns Hopkins Employer Health Plan Facility/Professional Facility Modifier Low / Median / High Price $240.00 / $240.00 / $240.00	Facility		$240.00	$240.00	$240.00
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $160.72 / $385.95 / $988.20	Facility		$160.72	$385.95	$988.20
Martin's Point Facility/Professional Facility Modifier QK Low / Median / High Price $154.75 / $217.17 / $228.66	Facility	QK	$154.75	$217.17	$228.66
Martin's Point Facility/Professional Facility Modifier QX Low / Median / High Price $276.32 / $585.14 / $682.67	Facility	QX	$276.32	$585.14	$682.67
Martin's Point Facility/Professional Facility Modifier QY Low / Median / High Price $82.17 / $99.78 / $187.62	Facility	QY	$82.17	$99.78	$187.62
Martin's Point Facility/Professional Professional Modifier AA Low / Median / High Price $225.50 / $570.00 / $997.13	Professional	AA	$225.50	$570.00	$997.13
Martin's Point Facility/Professional Professional Modifier QK Low / Median / High Price $96.64 / $263.75 / $338.04	Professional	QK	$96.64	$263.75	$338.04
Martin's Point Facility/Professional Professional Modifier QX Low / Median / High Price $98.13 / $257.89 / $338.84	Professional	QX	$98.13	$257.89	$338.84
Martin's Point Facility/Professional Professional Modifier QY Low / Median / High Price $86.91 / $239.98 / $297.95	Professional	QY	$86.91	$239.98	$297.95
Martin's Point Facility/Professional Professional Modifier QZ Low / Median / High Price $423.30 / $532.74 / $645.60	Professional	QZ	$423.30	$532.74	$645.60
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,438.65 / $1,507.64 / $1,842.24	Facility		$1,438.65	$1,507.64	$1,842.24
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