Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier QK Low / Median / High Price $199.68 / $199.68 / $340.43	Facility	QK	$199.68	$199.68	$340.43
Aetna Facility/Professional Facility Modifier QX Low / Median / High Price $494.64 / $552.96 / $942.73	Facility	QX	$494.64	$552.96	$942.73
Aetna Facility/Professional Facility Modifier QY Low / Median / High Price $178.62 / $287.29 / $339.38	Facility	QY	$178.62	$287.29	$339.38
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $172.06 / $765.00 / $1,540.00	Professional	AA	$172.06	$765.00	$1,540.00
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $124.57 / $354.54 / $479.09	Professional	QK	$124.57	$354.54	$479.09
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $138.27 / $352.43 / $469.86	Professional	QX	$138.27	$352.43	$469.86
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $251.94 / $323.74 / $404.58	Professional	QY	$251.94	$323.74	$404.58
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $557.33 / $680.03 / $838.30	Professional	QZ	$557.33	$680.03	$838.30
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $147.77 / $224.66 / $325.05	Professional	AA	$147.77	$224.66	$325.05
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $90.27 / $168.35 / $270.00	Professional	QK	$90.27	$168.35	$270.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $30.61 / $139.79 / $270.00	Professional	QX	$30.61	$139.79	$270.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $95.00 / $130.30 / $198.96	Professional	QY	$95.00	$130.30	$198.96
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $160.40 / $279.58 / $636.00	Professional	QZ	$160.40	$279.58	$636.00
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 / $360.00 / $360.00	Professional	QY	$180.00	$360.00	$360.00
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 $456.71 / $611.61 / $1,378.00	Professional	AA	$456.71	$611.61	$1,378.00
Highmark BCBS Facility/Professional Professional Modifier QK Low / Median / High Price $470.13 / $584.91 / $840.10	Professional	QK	$470.13	$584.91	$840.10
Highmark BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $455.73 / $575.12 / $804.01	Professional	QX	$455.73	$575.12	$804.01
Highmark BCBS Facility/Professional Professional Modifier QY Low / Median / High Price $437.18 / $595.76 / $737.50	Professional	QY	$437.18	$595.76	$737.50
Highmark BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $372.08 / $470.24 / $591.70	Professional	QZ	$372.08	$470.24	$591.70
Martin's Point Facility/Professional Facility Modifier QK Low / Median / High Price $199.68 / $340.43 / $340.43	Facility	QK	$199.68	$340.43	$340.43
Martin's Point Facility/Professional Facility Modifier QX Low / Median / High Price $494.64 / $795.56 / $942.73	Facility	QX	$494.64	$795.56	$942.73
Martin's Point Facility/Professional Facility Modifier QY Low / Median / High Price $178.62 / $287.29 / $339.38	Facility	QY	$178.62	$287.29	$339.38
Martin's Point Facility/Professional Professional Modifier AA Low / Median / High Price $211.36 / $729.00 / $1,530.00	Professional	AA	$211.36	$729.00	$1,530.00
Martin's Point Facility/Professional Professional Modifier QK Low / Median / High Price $126.02 / $348.45 / $474.37	Professional	QK	$126.02	$348.45	$474.37
Martin's Point Facility/Professional Professional Modifier QX Low / Median / High Price $147.78 / $347.31 / $464.86	Professional	QX	$147.78	$347.31	$464.86
Martin's Point Facility/Professional Professional Modifier QY Low / Median / High Price $238.69 / $319.64 / $409.05	Professional	QY	$238.69	$319.64	$409.05
Martin's Point Facility/Professional Professional Modifier QZ Low / Median / High Price $550.62 / $663.88 / $838.30	Professional	QZ	$550.62	$663.88	$838.30
Priority Health Facility/Professional Professional Modifier QK Low / Median / High Price $180.00 / $180.00 / $180.00	Professional	QK	$180.00	$180.00	$180.00
Priority Health Facility/Professional Professional Modifier QX Low / Median / High Price $180.00 / $180.00 / $180.00	Professional	QX	$180.00	$180.00	$180.00
Priority Health Facility/Professional Professional Modifier QY Low / Median / High Price $180.00 / $180.00 / $360.00	Professional	QY	$180.00	$180.00	$360.00