Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $131.83 / $977.24 / $1,737.80	Professional	AA	$131.83	$977.24	$1,737.80
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $295.12 / $363.08 / $660.69	Professional	QX	$295.12	$363.08	$660.69
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $407.38 / $524.81 / $1,000.00	Professional	QY	$407.38	$524.81	$1,000.00
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $100.00 / $467.74 / $977.24	Professional	QZ	$100.00	$467.74	$977.24
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $123.03 / $165.96 / $457.09	Professional	QZ	$123.03	$165.96	$457.09
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 $117.49 / $263.03 / $389.05	Professional	AA	$117.49	$263.03	$389.05
Geisinger Facility/Professional Professional Modifier QX Low / Median / High Price $117.49 / $263.03 / $389.05	Professional	QX	$117.49	$263.03	$389.05
Geisinger Facility/Professional Professional Modifier QY Low / Median / High Price $117.49 / $263.03 / $389.05	Professional	QY	$117.49	$263.03	$389.05
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 AA Low / Median / High Price $309.03 / $467.74 / $645.65	Professional	AA	$309.03	$467.74	$645.65
Highmark BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $416.87 / $602.56 / $912.01	Professional	QX	$416.87	$602.56	$912.01
Highmark BCBS Facility/Professional Professional Modifier QY Low / Median / High Price $467.74 / $549.54 / $724.44	Professional	QY	$467.74	$549.54	$724.44
Highmark BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $302.00 / $512.86 / $602.56	Professional	QZ	$302.00	$512.86	$602.56
Martin's Point Facility/Professional Professional Modifier AA Low / Median / High Price $123.03 / $954.99 / $1,905.46	Professional	AA	$123.03	$954.99	$1,905.46
Martin's Point Facility/Professional Professional Modifier QX Low / Median / High Price $295.12 / $389.05 / $660.69	Professional	QX	$295.12	$389.05	$660.69
Martin's Point Facility/Professional Professional Modifier QY Low / Median / High Price $407.38 / $512.86 / $1,000.00	Professional	QY	$407.38	$512.86	$1,000.00
Martin's Point Facility/Professional Professional Modifier QZ Low / Median / High Price $100.00 / $467.74 / $977.24	Professional	QZ	$100.00	$467.74	$977.24