Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $111.15 / $111.15 / $497.70	Facility		$111.15	$111.15	$497.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $111.15 / $111.15 / $128.94	Professional		$111.15	$111.15	$128.94
Cigna Facility/Professional Facility Modifier Low / Median / High Price $111.15 / $111.15 / $111.15	Facility		$111.15	$111.15	$111.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $111.15 / $111.15 / $317.25	Professional		$111.15	$111.15	$317.25
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $155.61 / $484.95	Professional		$100.00	$155.61	$484.95
Hally Health Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $100.00 / $100.00	Facility		$100.00	$100.00	$100.00
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $144.50 / $144.50 / $144.50	Professional		$144.50	$144.50	$144.50
Molina Facility/Professional Professional Modifier Low / Median / High Price $452.09 / $465.39 / $498.63	Professional		$452.09	$465.39	$498.63
United Facility/Professional Professional Modifier Low / Median / High Price $111.15 / $111.15 / $121.86	Professional		$111.15	$111.15	$121.86