Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $263.03 / $426.58 / $1,778.28	Professional	QZ	$263.03	$426.58	$1,778.28
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $162.18 / $162.18 / $162.18	Professional	QZ	$162.18	$162.18	$162.18
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 QZ Low / Median / High Price $117.49 / $263.03 / $389.05	Professional	QZ	$117.49	$263.03	$389.05
Highmark BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $269.15 / $380.19 / $389.05	Professional	QZ	$269.15	$380.19	$389.05
Martin's Point Facility/Professional Professional Modifier QZ Low / Median / High Price $263.03 / $263.03 / $426.58	Professional	QZ	$263.03	$263.03	$426.58