Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $223.87 / $870.96 / $1,995.26	Professional	QZ	$223.87	$870.96	$1,995.26
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $162.18 / $162.18 / $204.17	Professional	QZ	$162.18	$162.18	$204.17
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 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 QZ Low / Median / High Price $426.58 / $630.96 / $794.33	Professional	QZ	$426.58	$630.96	$794.33
Martin's Point Facility/Professional Professional Modifier QZ Low / Median / High Price $645.65 / $891.25 / $1,995.26	Professional	QZ	$645.65	$891.25	$1,995.26