Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier QK Low / Median / High Price $389.05 / $389.05 / $389.05	Facility	QK	$389.05	$389.05	$389.05
Aetna Facility/Professional Facility Modifier QX Low / Median / High Price $645.65 / $645.65 / $645.65	Facility	QX	$645.65	$645.65	$645.65
Aetna Facility/Professional Facility Modifier QY Low / Median / High Price $190.55 / $190.55 / $234.42	Facility	QY	$190.55	$190.55	$234.42
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $602.56 / $1,318.26 / $2,398.83	Professional	AA	$602.56	$1,318.26	$2,398.83
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $263.03 / $457.09 / $562.34	Professional	AA	$263.03	$457.09	$562.34
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 $93.33 / $213.80 / $309.03	Professional	AA	$93.33	$213.80	$309.03
Highmark BCBS Facility/Professional Professional Modifier AA Low / Median / High Price $398.11 / $645.65 / $1,071.52	Professional	AA	$398.11	$645.65	$1,071.52
Martin's Point Facility/Professional Facility Modifier QK Low / Median / High Price $389.05 / $389.05 / $389.05	Facility	QK	$389.05	$389.05	$389.05
Martin's Point Facility/Professional Facility Modifier QX Low / Median / High Price $645.65 / $645.65 / $645.65	Facility	QX	$645.65	$645.65	$645.65
Martin's Point Facility/Professional Facility Modifier QY Low / Median / High Price $190.55 / $190.55 / $234.42	Facility	QY	$190.55	$190.55	$234.42
Martin's Point Facility/Professional Professional Modifier AA Low / Median / High Price $457.09 / $1,230.27 / $2,290.87	Professional	AA	$457.09	$1,230.27	$2,290.87