Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier QK Low / Median / High Price $295.12 / $323.59 / $407.38	Facility	QK	$295.12	$323.59	$407.38
Aetna Facility/Professional Facility Modifier QX Low / Median / High Price $812.83 / $891.25 / $1,548.82	Facility	QX	$812.83	$891.25	$1,548.82
Aetna Facility/Professional Facility Modifier QY Low / Median / High Price $295.12 / $295.12 / $446.68	Facility	QY	$295.12	$295.12	$446.68
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $616.60 / $1,258.93 / $2,041.74	Professional	AA	$616.60	$1,258.93	$2,041.74
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $489.78 / $1,023.29 / $1,862.09	Professional	QZ	$489.78	$1,023.29	$1,862.09
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $524.81 / $645.65 / $776.25	Professional	AA	$524.81	$645.65	$776.25
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $162.18 / $213.80 / $251.19	Professional	QZ	$162.18	$213.80	$251.19
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 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 $457.09 / $691.83 / $1,096.48	Professional	AA	$457.09	$691.83	$1,096.48
Highmark BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $398.11 / $457.09 / $676.08	Professional	QZ	$398.11	$457.09	$676.08
Martin's Point Facility/Professional Facility Modifier QK Low / Median / High Price $295.12 / $323.59 / $407.38	Facility	QK	$295.12	$323.59	$407.38
Martin's Point Facility/Professional Facility Modifier QX Low / Median / High Price $812.83 / $891.25 / $1,548.82	Facility	QX	$812.83	$891.25	$1,548.82
Martin's Point Facility/Professional Facility Modifier QY Low / Median / High Price $295.12 / $295.12 / $446.68	Facility	QY	$295.12	$295.12	$446.68
Martin's Point Facility/Professional Professional Modifier AA Low / Median / High Price $645.65 / $1,288.25 / $2,089.30	Professional	AA	$645.65	$1,288.25	$2,089.30
Martin's Point Facility/Professional Professional Modifier QZ Low / Median / High Price $467.74 / $954.99 / $1,862.09	Professional	QZ	$467.74	$954.99	$1,862.09