Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $158.91 / $158.91 / $158.91	Facility		$158.91	$158.91	$158.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $158.91 / $201.82 / $486.60	Professional		$158.91	$201.82	$486.60
Cigna Facility/Professional Facility Modifier Low / Median / High Price $152.91 / $158.91 / $158.91	Facility		$152.91	$158.91	$158.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $158.91 / $158.91 / $158.91	Professional		$158.91	$158.91	$158.91
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $148.24 / $177.88	Professional		$32.34	$148.24	$177.88
Providence Facility/Professional Facility Modifier Low / Median / High Price $76.79 / $158.91 / $166.86	Facility		$76.79	$158.91	$166.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $158.91 / $158.91 / $158.91	Professional		$158.91	$158.91	$158.91
United Facility/Professional Professional Modifier Low / Median / High Price $158.91 / $158.91 / $158.91	Professional		$158.91	$158.91	$158.91