Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $30.00 / $429.48 / $518.52	Facility		$30.00	$429.48	$518.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.00 / $41.00 / $502.74	Professional		$30.00	$41.00	$502.74
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $621.82 / $1,260.00 / $1,260.00	Professional	AA	$621.82	$1,260.00	$1,260.00
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $219.72 / $332.14 / $385.20	Professional	QX	$219.72	$332.14	$385.20
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $219.72 / $219.72 / $270.10	Professional	QY	$219.72	$219.72	$270.10
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $120.30 / $120.30 / $120.30	Professional	QZ	$120.30	$120.30	$120.30
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $204.00 / $330.00 / $494.40	Professional		$204.00	$330.00	$494.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $230.00 / $320.00 / $450.00	Professional		$230.00	$320.00	$450.00
Cigna Facility/Professional Professional Modifier QX Low / Median / High Price $180.00 / $180.00 / $180.00	Professional	QX	$180.00	$180.00	$180.00
Cigna Facility/Professional Professional Modifier QY Low / Median / High Price $180.00 / $360.00 / $360.00	Professional	QY	$180.00	$360.00	$360.00
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $450.00 / $450.00 / $450.00	Facility		$450.00	$450.00	$450.00
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $115.10 / $510.00 / $864.00	Professional		$115.10	$510.00	$864.00
Highmark BCBS Facility/Professional Professional Modifier AA Low / Median / High Price $405.96 / $473.62 / $587.20	Professional	AA	$405.96	$473.62	$587.20
Highmark BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $412.73 / $512.65 / $683.37	Professional	QX	$412.73	$512.65	$683.37
Highmark BCBS Facility/Professional Professional Modifier QY Low / Median / High Price $430.81 / $431.53 / $481.08	Professional	QY	$430.81	$431.53	$481.08
Highmark BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $240.50 / $435.24 / $534.52	Professional	QZ	$240.50	$435.24	$534.52
Johns Hopkins Employer Health Plan Facility/Professional Facility Modifier Low / Median / High Price $360.00 / $360.00 / $360.00	Facility		$360.00	$360.00	$360.00
Johns Hopkins Employer Health Plan Facility/Professional Professional Modifier Low / Median / High Price $252.00 / $330.00 / $570.00	Professional		$252.00	$330.00	$570.00
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $48.00 / $390.00 / $480.84	Facility		$48.00	$390.00	$480.84
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $31.82 / $360.00 / $502.74	Professional		$31.82	$360.00	$502.74
Martin's Point Facility/Professional Professional Modifier AA Low / Median / High Price $621.82 / $621.82 / $1,260.00	Professional	AA	$621.82	$621.82	$1,260.00
Martin's Point Facility/Professional Professional Modifier QX Low / Median / High Price $219.72 / $327.84 / $385.20	Professional	QX	$219.72	$327.84	$385.20
Martin's Point Facility/Professional Professional Modifier QY Low / Median / High Price $219.72 / $219.72 / $270.10	Professional	QY	$219.72	$219.72	$270.10
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $5.00 / $30.27 / $42.34	Professional		$5.00	$30.27	$42.34
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $235.00 / $325.00 / $450.00	Professional		$235.00	$325.00	$450.00
Priority Health Facility/Professional Professional Modifier QX Low / Median / High Price $180.00 / $180.00 / $180.00	Professional	QX	$180.00	$180.00	$180.00
Priority Health Facility/Professional Professional Modifier QY Low / Median / High Price $180.00 / $180.00 / $360.00	Professional	QY	$180.00	$180.00	$360.00
United Facility/Professional Professional Modifier Low / Median / High Price $42.00 / $57.12 / $78.00	Professional		$42.00	$57.12	$78.00