Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $173.00 / $173.00 / $173.00	Facility		$173.00	$173.00	$173.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $173.00 / $173.00 / $173.00	Professional		$173.00	$173.00	$173.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $263.02 / $263.02 / $263.02	Facility		$263.02	$263.02	$263.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $192.01 / $263.02 / $263.02	Professional		$192.01	$263.02	$263.02
Medcost Facility/Professional Facility Modifier Low / Median / High Price $173.00 / $173.00 / $233.55	Facility		$173.00	$173.00	$233.55
Medcost Facility/Professional Professional Modifier Low / Median / High Price $173.00 / $173.00 / $173.00	Professional		$173.00	$173.00	$173.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.00 / $30.00 / $55.00	Professional		$30.00	$30.00	$55.00
United Facility/Professional Professional Modifier Low / Median / High Price $93.21 / $93.21 / $93.21	Professional		$93.21	$93.21	$93.21