Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $138.04 / $323.59	Facility		$138.04	$138.04	$323.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $134.90 / $162.18	Professional		$128.82	$134.90	$162.18
Cigna Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $138.04 / $549.54	Facility		$138.04	$138.04	$549.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $138.04 / $169.82	Professional		$138.04	$138.04	$169.82
Molina Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $64.57 / $75.86	Professional		$64.57	$64.57	$75.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $181.97 / $218.78 / $218.78	Facility		$181.97	$218.78	$218.78
United Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $331.13 / $331.13	Professional		$331.13	$331.13	$331.13
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $138.04 / $138.04	Professional		$138.04	$138.04	$138.04