Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier QK Low / Median / High Price $199.53 / $199.53 / $338.84	Facility	QK	$199.53	$199.53	$338.84
Aetna Facility/Professional Facility Modifier QX Low / Median / High Price $549.54 / $831.76 / $933.25	Facility	QX	$549.54	$831.76	$933.25
Aetna Facility/Professional Facility Modifier QY Low / Median / High Price $295.12 / $295.12 / $338.84	Facility	QY	$295.12	$295.12	$338.84
Aetna Facility/Professional Facility Modifier QZ Low / Median / High Price $977.24 / $977.24 / $977.24	Facility	QZ	$977.24	$977.24	$977.24
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $323.59 / $977.24 / $1,737.80	Professional	AA	$323.59	$977.24	$1,737.80
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $194.98 / $380.19 / $660.69	Professional	QK	$194.98	$380.19	$660.69
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $213.80 / $380.19 / $660.69	Professional	QX	$213.80	$380.19	$660.69
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $288.40 / $398.11 / $758.58	Professional	QY	$288.40	$398.11	$758.58
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $467.74 / $691.83 / $1,513.56	Professional	QZ	$467.74	$691.83	$1,513.56
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $141.25 / $223.87 / $524.81	Professional	AA	$141.25	$223.87	$524.81
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $70.79 / $109.65 / $295.12	Professional	QK	$70.79	$109.65	$295.12
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $60.26 / $91.20 / $295.12	Professional	QX	$60.26	$91.20	$295.12
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $85.11 / $138.04 / $229.09	Professional	QY	$85.11	$138.04	$229.09
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $138.04 / $181.97 / $457.09	Professional	QZ	$138.04	$181.97	$457.09
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 QK Low / Median / High Price $141.25 / $316.23 / $467.74	Professional	QK	$141.25	$316.23	$467.74
Geisinger Facility/Professional Professional Modifier QX Low / Median / High Price $141.25 / $316.23 / $467.74	Professional	QX	$141.25	$316.23	$467.74
Geisinger Facility/Professional Professional Modifier QY Low / Median / High Price $141.25 / $316.23 / $467.74	Professional	QY	$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 Facility Modifier QZ Low / Median / High Price $61.66 / $61.66 / $61.66	Facility	QZ	$61.66	$61.66	$61.66
Highmark BCBS Facility/Professional Professional Modifier AA Low / Median / High Price $467.74 / $588.84 / $1,412.54	Professional	AA	$467.74	$588.84	$1,412.54
Highmark BCBS Facility/Professional Professional Modifier QK Low / Median / High Price $478.63 / $602.56 / $831.76	Professional	QK	$478.63	$602.56	$831.76
Highmark BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $467.74 / $575.44 / $758.58	Professional	QX	$467.74	$575.44	$758.58
Highmark BCBS Facility/Professional Professional Modifier QY Low / Median / High Price $467.74 / $602.56 / $776.25	Professional	QY	$467.74	$602.56	$776.25
Highmark BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $380.19 / $489.78 / $602.56	Professional	QZ	$380.19	$489.78	$602.56
Martin's Point Facility/Professional Facility Modifier QK Low / Median / High Price $199.53 / $199.53 / $338.84	Facility	QK	$199.53	$199.53	$338.84
Martin's Point Facility/Professional Facility Modifier QX Low / Median / High Price $549.54 / $831.76 / $933.25	Facility	QX	$549.54	$831.76	$933.25
Martin's Point Facility/Professional Facility Modifier QY Low / Median / High Price $295.12 / $295.12 / $338.84	Facility	QY	$295.12	$295.12	$338.84
Martin's Point Facility/Professional Facility Modifier QZ Low / Median / High Price $977.24 / $977.24 / $977.24	Facility	QZ	$977.24	$977.24	$977.24
Martin's Point Facility/Professional Professional Modifier AA Low / Median / High Price $457.09 / $1,047.13 / $1,778.28	Professional	AA	$457.09	$1,047.13	$1,778.28
Martin's Point Facility/Professional Professional Modifier QK Low / Median / High Price $245.47 / $398.11 / $676.08	Professional	QK	$245.47	$398.11	$676.08
Martin's Point Facility/Professional Professional Modifier QX Low / Median / High Price $239.88 / $389.05 / $724.44	Professional	QX	$239.88	$389.05	$724.44
Martin's Point Facility/Professional Professional Modifier QY Low / Median / High Price $302.00 / $426.58 / $831.76	Professional	QY	$302.00	$426.58	$831.76
Martin's Point Facility/Professional Professional Modifier QZ Low / Median / High Price $446.68 / $691.83 / $1,548.82	Professional	QZ	$446.68	$691.83	$1,548.82