Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $30.00 / $572.64 / $700.32	Facility		$30.00	$572.64	$700.32
Aetna Facility/Professional Facility Modifier QK Low / Median / High Price $142.74 / $142.74 / $142.74	Facility	QK	$142.74	$142.74	$142.74
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $798.10 / $1,188.22 / $1,820.00	Professional	AA	$798.10	$1,188.22	$1,820.00
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $153.76 / $449.45 / $644.77	Professional	QK	$153.76	$449.45	$644.77
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $170.92 / $494.90 / $697.00	Professional	QX	$170.92	$494.90	$697.00
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $451.00 / $451.00 / $451.00	Professional	QZ	$451.00	$451.00	$451.00
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $306.10 / $397.92 / $487.64	Professional	AA	$306.10	$397.92	$487.64
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $178.78 / $211.28 / $300.00	Professional	QK	$178.78	$211.28	$300.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $15.30 / $178.78 / $330.00	Professional	QX	$15.30	$178.78	$330.00
Cigna Facility/Professional Professional Modifier QK Low / Median / High Price $240.00 / $240.00 / $240.00	Professional	QK	$240.00	$240.00	$240.00
Cigna Facility/Professional Professional Modifier QX Low / Median / High Price $240.00 / $240.00 / $240.00	Professional	QX	$240.00	$240.00	$240.00
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $600.00 / $600.00 / $600.00	Facility		$600.00	$600.00	$600.00
Highmark BCBS Facility/Professional Professional Modifier AA Low / Median / High Price $642.77 / $1,026.58 / $1,794.25	Professional	AA	$642.77	$1,026.58	$1,794.25
Highmark BCBS Facility/Professional Professional Modifier QK Low / Median / High Price $581.88 / $741.00 / $1,219.59	Professional	QK	$581.88	$741.00	$1,219.59
Highmark BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $618.00 / $792.82 / $1,860.30	Professional	QX	$618.00	$792.82	$1,860.30
Highmark BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $480.60 / $611.91 / $703.67	Professional	QZ	$480.60	$611.91	$703.67
Johns Hopkins Employer Health Plan Facility/Professional Facility Modifier Low / Median / High Price $480.00 / $480.00 / $480.00	Facility		$480.00	$480.00	$480.00
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $320.00 / $521.36 / $766.70	Facility		$320.00	$521.36	$766.70
Martin's Point Facility/Professional Facility Modifier QK Low / Median / High Price $142.74 / $142.74 / $142.74	Facility	QK	$142.74	$142.74	$142.74
Martin's Point Facility/Professional Professional Modifier AA Low / Median / High Price $695.59 / $1,062.35 / $1,820.00	Professional	AA	$695.59	$1,062.35	$1,820.00
Martin's Point Facility/Professional Professional Modifier QK Low / Median / High Price $158.41 / $438.49 / $636.29	Professional	QK	$158.41	$438.49	$636.29
Martin's Point Facility/Professional Professional Modifier QX Low / Median / High Price $170.92 / $476.31 / $684.37	Professional	QX	$170.92	$476.31	$684.37
Martin's Point Facility/Professional Professional Modifier QZ Low / Median / High Price $451.00 / $477.36 / $777.24	Professional	QZ	$451.00	$477.36	$777.24
Priority Health Facility/Professional Professional Modifier QK Low / Median / High Price $240.00 / $240.00 / $240.00	Professional	QK	$240.00	$240.00	$240.00
Priority Health Facility/Professional Professional Modifier QX Low / Median / High Price $240.00 / $240.00 / $240.00	Professional	QX	$240.00	$240.00	$240.00