Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier QY Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	QY	$100.00	$100.00	$100.00
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $218.78 / $371.54 / $1,122.02	Professional	QZ	$218.78	$371.54	$1,122.02
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $165.96 / $165.96 / $165.96	Professional	QZ	$165.96	$165.96	$165.96
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 $93.33 / $213.80 / $309.03	Professional	QZ	$93.33	$213.80	$309.03
Highmark BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $263.03 / $295.12 / $426.58	Professional	QZ	$263.03	$295.12	$426.58
Martin's Point Facility/Professional Facility Modifier QY Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	QY	$100.00	$100.00	$100.00
Martin's Point Facility/Professional Professional Modifier QZ Low / Median / High Price $218.78 / $363.08 / $1,122.02	Professional	QZ	$218.78	$363.08	$1,122.02