Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier QX Low / Median / High Price $1,230.27 / $1,230.27 / $5,623.41	Facility	QX	$1,230.27	$1,230.27	$5,623.41
Aetna Facility/Professional Facility Modifier QY Low / Median / High Price $436.52 / $436.52 / $2,041.74	Facility	QY	$436.52	$436.52	$2,041.74
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $870.96 / $1,862.09 / $3,311.31	Professional	AA	$870.96	$1,862.09	$3,311.31
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $223.87 / $524.81 / $1,023.29	Professional	QX	$223.87	$524.81	$1,023.29
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $173.78 / $602.56 / $1,380.38	Professional	QY	$173.78	$602.56	$1,380.38
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $645.65 / $1,288.25 / $2,951.21	Professional	QZ	$645.65	$1,288.25	$2,951.21
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $302.00 / $588.84 / $1,047.13	Professional	AA	$302.00	$588.84	$1,047.13
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $102.33 / $147.91 / $389.05	Professional	QX	$102.33	$147.91	$389.05
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $223.87 / $389.05 / $524.81	Professional	QZ	$223.87	$389.05	$524.81
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 $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 $501.19 / $1,000.00 / $2,089.30	Professional	AA	$501.19	$1,000.00	$2,089.30
Highmark BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $562.34 / $812.83 / $1,258.93	Professional	QX	$562.34	$812.83	$1,258.93
Highmark BCBS Facility/Professional Professional Modifier QY Low / Median / High Price $501.19 / $691.83 / $1,258.93	Professional	QY	$501.19	$691.83	$1,258.93
Highmark BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $478.63 / $616.60 / $1,000.00	Professional	QZ	$478.63	$616.60	$1,000.00
Martin's Point Facility/Professional Facility Modifier QX Low / Median / High Price $1,230.27 / $1,230.27 / $5,623.41	Facility	QX	$1,230.27	$1,230.27	$5,623.41
Martin's Point Facility/Professional Facility Modifier QY Low / Median / High Price $436.52 / $436.52 / $2,041.74	Facility	QY	$436.52	$436.52	$2,041.74
Martin's Point Facility/Professional Professional Modifier AA Low / Median / High Price $776.25 / $1,819.70 / $3,311.31	Professional	AA	$776.25	$1,819.70	$3,311.31
Martin's Point Facility/Professional Professional Modifier QX Low / Median / High Price $239.88 / $588.84 / $1,174.90	Professional	QX	$239.88	$588.84	$1,174.90
Martin's Point Facility/Professional Professional Modifier QY Low / Median / High Price $251.19 / $645.65 / $1,479.11	Professional	QY	$251.19	$645.65	$1,479.11
Martin's Point Facility/Professional Professional Modifier QZ Low / Median / High Price $660.69 / $1,412.54 / $3,019.95	Professional	QZ	$660.69	$1,412.54	$3,019.95