Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $109.65 / $758.58 / $1,698.24	Professional	AA	$109.65	$758.58	$1,698.24
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $245.47 / $363.08 / $588.84	Professional	QX	$245.47	$363.08	$588.84
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $218.78 / $371.54 / $489.78	Professional	QY	$218.78	$371.54	$489.78
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $72.44 / $269.15 / $616.60	Professional	QZ	$72.44	$269.15	$616.60
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $52.48 / $52.48 / $52.48	Professional	QX	$52.48	$52.48	$52.48
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $81.28 / $100.00 / $323.59	Professional	QZ	$81.28	$100.00	$323.59
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 $93.33 / $213.80 / $309.03	Professional	AA	$93.33	$213.80	$309.03
Geisinger Facility/Professional Professional Modifier QX Low / Median / High Price $93.33 / $213.80 / $309.03	Professional	QX	$93.33	$213.80	$309.03
Geisinger Facility/Professional Professional Modifier QY Low / Median / High Price $93.33 / $213.80 / $309.03	Professional	QY	$93.33	$213.80	$309.03
Geisinger Facility/Professional Professional Modifier QZ Low / Median / High Price $93.33 / $213.80 / $309.03	Professional	QZ	$93.33	$213.80	$309.03
Highmark BCBS Facility/Professional Professional Modifier AA Low / Median / High Price $281.84 / $346.74 / $602.56	Professional	AA	$281.84	$346.74	$602.56
Highmark BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $302.00 / $380.19 / $512.86	Professional	QX	$302.00	$380.19	$512.86
Highmark BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $269.15 / $302.00 / $380.19	Professional	QZ	$269.15	$302.00	$380.19
Martin's Point Facility/Professional Professional Modifier AA Low / Median / High Price $234.42 / $812.83 / $1,905.46	Professional	AA	$234.42	$812.83	$1,905.46
Martin's Point Facility/Professional Professional Modifier QX Low / Median / High Price $257.04 / $398.11 / $741.31	Professional	QX	$257.04	$398.11	$741.31
Martin's Point Facility/Professional Professional Modifier QY Low / Median / High Price $218.78 / $281.84 / $1,202.26	Professional	QY	$218.78	$281.84	$1,202.26
Martin's Point Facility/Professional Professional Modifier QZ Low / Median / High Price $72.44 / $269.15 / $616.60	Professional	QZ	$72.44	$269.15	$616.60