Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $30.20 / $426.58 / $524.81	Facility		$30.20	$426.58	$524.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $52.48 / $741.31	Professional		$30.20	$52.48	$741.31
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $154.88 / $616.60 / $2,570.40	Professional	AA	$154.88	$616.60	$2,570.40
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $218.78 / $346.74 / $537.03	Professional	QX	$218.78	$346.74	$537.03
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $218.78 / $269.15 / $602.56	Professional	QY	$218.78	$269.15	$602.56
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $131.83 / $407.38 / $1,122.02	Professional	QZ	$131.83	$407.38	$1,122.02
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $70.79 / $77.62 / $208.93	Professional	QX	$70.79	$77.62	$208.93
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $120.23 / $141.25 / $389.05	Professional	QZ	$120.23	$141.25	$389.05
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $288.40 / $457.09	Professional		$204.17	$288.40	$457.09
Cigna Facility/Professional Facility Modifier Low / Median / High Price $61.66 / $61.66 / $61.66	Facility		$61.66	$61.66	$61.66
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
Cigna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $323.59 / $478.63	Professional		$229.09	$323.59	$478.63
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $446.68 / $446.68 / $446.68	Facility		$446.68	$446.68	$446.68
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $489.78 / $870.96	Professional		$109.65	$489.78	$870.96
Geisinger Facility/Professional Professional Modifier AA Low / Median / High Price $141.25 / $316.23 / $467.74	Professional	AA	$141.25	$316.23	$467.74
Geisinger Facility/Professional Professional Modifier QX Low / Median / High Price $141.25 / $316.23 / $467.74	Professional	QX	$141.25	$316.23	$467.74
Geisinger Facility/Professional Professional Modifier QY Low / Median / High Price $141.25 / $316.23 / $467.74	Professional	QY	$141.25	$316.23	$467.74
Geisinger Facility/Professional Professional Modifier QZ Low / Median / High Price $141.25 / $316.23 / $467.74	Professional	QZ	$141.25	$316.23	$467.74
Highmark BCBS Facility/Professional Professional Modifier AA Low / Median / High Price $380.19 / $457.09 / $575.44	Professional	AA	$380.19	$457.09	$575.44
Highmark BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $398.11 / $524.81 / $831.76	Professional	QX	$398.11	$524.81	$831.76
Highmark BCBS Facility/Professional Professional Modifier QY Low / Median / High Price $436.52 / $436.52 / $478.63	Professional	QY	$436.52	$436.52	$478.63
Highmark BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $309.03 / $371.54 / $501.19	Professional	QZ	$309.03	$371.54	$501.19
Johns Hopkins Employer Health Plan Facility/Professional Facility Modifier Low / Median / High Price $363.08 / $363.08 / $363.08	Facility		$363.08	$363.08	$363.08
Johns Hopkins Employer Health Plan Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $331.13 / $446.68	Professional		$251.19	$331.13	$446.68
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $47.86 / $389.05 / $501.19	Facility		$47.86	$389.05	$501.19
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $389.05 / $660.69	Professional		$39.81	$389.05	$660.69
Martin's Point Facility/Professional Professional Modifier AA Low / Median / High Price $147.91 / $1,047.13 / $2,630.27	Professional	AA	$147.91	$1,047.13	$2,630.27
Martin's Point Facility/Professional Professional Modifier QX Low / Median / High Price $218.78 / $346.74 / $562.34	Professional	QX	$218.78	$346.74	$562.34
Martin's Point Facility/Professional Professional Modifier QY Low / Median / High Price $70.79 / $295.12 / $602.56	Professional	QY	$70.79	$295.12	$602.56
Martin's Point Facility/Professional Professional Modifier QZ Low / Median / High Price $131.83 / $346.74 / $1,122.02	Professional	QZ	$131.83	$346.74	$1,122.02
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $5.01 / $10.00 / $81.28	Professional		$5.01	$10.00	$81.28
United Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $57.54 / $79.43	Professional		$39.81	$57.54	$79.43