Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $120.00 / $120.00 / $120.00	Facility		$120.00	$120.00	$120.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $120.00 / $120.00 / $127.50	Professional		$120.00	$120.00	$127.50
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $108.37 / $127.50 / $142.50	Professional		$108.37	$127.50	$142.50
Cigna Facility/Professional Facility Modifier Low / Median / High Price $127.50 / $127.50 / $127.50	Facility		$127.50	$127.50	$127.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $127.50 / $127.50 / $127.50	Professional		$127.50	$127.50	$127.50
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $120.00 / $121.50 / $178.80	Facility		$120.00	$121.50	$178.80
Medica Facility/Professional Facility Modifier Low / Median / High Price $120.00 / $121.50 / $180.00	Facility		$120.00	$121.50	$180.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $150.00 / $150.00 / $205.38	Professional		$150.00	$150.00	$205.38
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $58.40 / $85.00	Professional		$50.00	$58.40	$85.00
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $120.00 / $120.00 / $178.80	Facility		$120.00	$120.00	$178.80
Quartz Facility/Professional Professional Modifier Low / Median / High Price $5,900.00 / $5,900.00 / $5,900.00	Professional		$5,900.00	$5,900.00	$5,900.00
Quartz Facility/Professional Facility Modifier Low / Median / High Price $65.00 / $150.00 / $562.50	Facility		$65.00	$150.00	$562.50
Quartz Facility/Professional Professional Modifier Low / Median / High Price $127.50 / $127.50 / $570.00	Professional		$127.50	$127.50	$570.00
United Facility/Professional Professional Modifier Low / Median / High Price $150.00 / $150.00 / $180.00	Professional		$150.00	$150.00	$180.00