Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $2,041.74 / $2,041.74 / $2,041.74	Professional	QZ	$2,041.74	$2,041.74	$2,041.74
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 $186.21 / $426.58 / $630.96	Professional	QZ	$186.21	$426.58	$630.96
Martin's Point Facility/Professional Professional Modifier QZ Low / Median / High Price $2,041.74 / $2,041.74 / $2,041.74	Professional	QZ	$2,041.74	$2,041.74	$2,041.74