Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $713.50 / $713.50 / $713.50	Facility		$713.50	$713.50	$713.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $713.50 / $720.64 / $906.15	Professional		$713.50	$720.64	$906.15
Cigna Facility/Professional Facility Modifier Low / Median / High Price $713.50 / $713.50 / $713.50	Facility		$713.50	$713.50	$713.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $713.50 / $713.50 / $713.50	Professional		$713.50	$713.50	$713.50
Molina Facility/Professional Professional Modifier Low / Median / High Price $975.26 / $1,589.67 / $1,589.67	Professional		$975.26	$1,589.67	$1,589.67
Providence Facility/Professional Facility Modifier Low / Median / High Price $713.50 / $713.50 / $906.15	Facility		$713.50	$713.50	$906.15
Providence Facility/Professional Professional Modifier Low / Median / High Price $713.50 / $713.50 / $1,600.93	Professional		$713.50	$713.50	$1,600.93
United Facility/Professional Facility Modifier Low / Median / High Price $975.26 / $975.26 / $975.26	Facility		$975.26	$975.26	$975.26
United Facility/Professional Professional Modifier Low / Median / High Price $713.50 / $713.50 / $713.50	Professional		$713.50	$713.50	$713.50