Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier QY Low / Median / High Price $776.25 / $776.25 / $776.25	Facility	QY	$776.25	$776.25	$776.25
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $1,258.93 / $2,041.74 / $3,019.95	Professional	AA	$1,258.93	$2,041.74	$3,019.95
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $1,513.56 / $1,584.89 / $3,019.95	Professional	QZ	$1,513.56	$1,584.89	$3,019.95
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $776.25 / $776.25 / $977.24	Professional	AA	$776.25	$776.25	$977.24
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $323.59 / $323.59 / $363.08	Professional	QZ	$323.59	$323.59	$363.08
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 $162.18 / $371.54 / $549.54	Professional	AA	$162.18	$371.54	$549.54
Geisinger Facility/Professional Professional Modifier QZ Low / Median / High Price $162.18 / $371.54 / $549.54	Professional	QZ	$162.18	$371.54	$549.54
Highmark BCBS Facility/Professional Professional Modifier AA Low / Median / High Price $1,258.93 / $1,548.82 / $2,344.23	Professional	AA	$1,258.93	$1,548.82	$2,344.23
Highmark BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $645.65 / $660.69 / $1,258.93	Professional	QZ	$645.65	$660.69	$1,258.93
Martin's Point Facility/Professional Facility Modifier QY Low / Median / High Price $776.25 / $776.25 / $776.25	Facility	QY	$776.25	$776.25	$776.25
Martin's Point Facility/Professional Professional Modifier AA Low / Median / High Price $1,174.90 / $2,290.87 / $3,090.30	Professional	AA	$1,174.90	$2,290.87	$3,090.30
Martin's Point Facility/Professional Professional Modifier QZ Low / Median / High Price $1,513.56 / $1,584.89 / $3,019.95	Professional	QZ	$1,513.56	$1,584.89	$3,019.95