Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $425.00 / $425.00 / $425.00	Facility		$425.00	$425.00	$425.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $425.00 / $425.00 / $475.00	Professional		$425.00	$425.00	$475.00
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $425.00 / $425.00 / $600.00	Facility		$425.00	$425.00	$600.00
Medica Facility/Professional Facility Modifier Low / Median / High Price $425.00 / $425.00 / $722.50	Facility		$425.00	$425.00	$722.50
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $70.00 / $85.00	Professional		$50.00	$70.00	$85.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $425.00 / $425.00 / $600.00	Facility		$425.00	$425.00	$600.00
United Facility/Professional Facility Modifier Low / Median / High Price $644.41 / $644.41 / $644.41	Facility		$644.41	$644.41	$644.41