Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $645.65 / $1,071.52 / $2,344.23	Professional	AA	$645.65	$1,071.52	$2,344.23
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $398.11 / $478.63 / $851.14	Professional	QZ	$398.11	$478.63	$851.14
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $165.96 / $165.96 / $323.59	Professional	QZ	$165.96	$165.96	$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 $117.49 / $263.03 / $389.05	Professional	AA	$117.49	$263.03	$389.05
Geisinger Facility/Professional Professional Modifier QZ Low / Median / High Price $117.49 / $263.03 / $389.05	Professional	QZ	$117.49	$263.03	$389.05
Highmark BCBS Facility/Professional Professional Modifier AA Low / Median / High Price $331.13 / $501.19 / $1,737.80	Professional	AA	$331.13	$501.19	$1,737.80
Highmark BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $275.42 / $288.40 / $389.05	Professional	QZ	$275.42	$288.40	$389.05
Martin's Point Facility/Professional Professional Modifier AA Low / Median / High Price $549.54 / $1,071.52 / $3,090.30	Professional	AA	$549.54	$1,071.52	$3,090.30
Martin's Point Facility/Professional Professional Modifier QZ Low / Median / High Price $398.11 / $478.63 / $851.14	Professional	QZ	$398.11	$478.63	$851.14