Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $133.13 / $133.13 / $133.13	Facility		$133.13	$133.13	$133.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.49 / $130.91 / $153.47	Professional		$52.49	$130.91	$153.47
Cigna Facility/Professional Facility Modifier Low / Median / High Price $393.79 / $460.17 / $705.92	Facility		$393.79	$460.17	$705.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.28 / $166.47 / $271.86	Professional		$114.28	$166.47	$271.86
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $65.22 / $133.32 / $173.32	Facility		$65.22	$133.32	$173.32
Medica Facility/Professional Facility Modifier Low / Median / High Price $62.74 / $133.32 / $174.43	Facility		$62.74	$133.32	$174.43
Medica Facility/Professional Professional Modifier Low / Median / High Price $167.57 / $369.42 / $935.43	Professional		$167.57	$369.42	$935.43
Molina Facility/Professional Professional Modifier Low / Median / High Price $55.00 / $133.32 / $265.88	Professional		$55.00	$133.32	$265.88
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $65.22 / $133.32 / $173.32	Facility		$65.22	$133.32	$173.32
Quartz Facility/Professional Professional Modifier Low / Median / High Price $89.25 / $182.31 / $339.97	Professional		$89.25	$182.31	$339.97
Quartz Facility/Professional Facility Modifier Low / Median / High Price $134.02 / $134.02 / $134.02	Facility		$134.02	$134.02	$134.02
Quartz Facility/Professional Professional Modifier Low / Median / High Price $301.55 / $676.60 / $935.43	Professional		$301.55	$676.60	$935.43
United Facility/Professional Professional Modifier Low / Median / High Price $163.19 / $289.76 / $522.46	Professional		$163.19	$289.76	$522.46