Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.05 / $67.05 / $67.05	Professional		$67.05	$67.05	$67.05
Cigna Facility/Professional Facility Modifier Low / Median / High Price $116.20 / $116.20 / $138.13	Facility		$116.20	$116.20	$138.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $116.20 / $116.20 / $116.20	Professional		$116.20	$116.20	$116.20
Providence Facility/Professional Facility Modifier Low / Median / High Price $116.20 / $116.20 / $138.13	Facility		$116.20	$116.20	$138.13
Providence Facility/Professional Professional Modifier Low / Median / High Price $74.23 / $116.20 / $147.96	Professional		$74.23	$116.20	$147.96
United Facility/Professional Professional Modifier Low / Median / High Price $77.08 / $96.76 / $114.81	Professional		$77.08	$96.76	$114.81