Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $190.55 / $190.55 / $190.55	Facility		$190.55	$190.55	$190.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $190.55 / $190.55	Professional		$190.55	$190.55	$190.55
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $194.98 / $194.98	Professional		$194.98	$194.98	$194.98
BCBS Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $151.36 / $151.36	Professional		$151.36	$151.36	$151.36
Cigna Facility/Professional Facility Modifier Low / Median / High Price $190.55 / $190.55 / $190.55	Facility		$190.55	$190.55	$190.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $190.55 / $190.55	Professional		$190.55	$190.55	$190.55
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $512.86 / $512.86 / $512.86	Facility		$512.86	$512.86	$512.86
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $190.55 / $190.55 / $275.42	Facility		$190.55	$190.55	$275.42
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $190.55 / $190.55	Professional		$190.55	$190.55	$190.55
Molina Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $134.90 / $190.55	Professional		$134.90	$134.90	$190.55
Providence Facility/Professional Facility Modifier Low / Median / High Price $190.55 / $275.42 / $602.56	Facility		$190.55	$275.42	$602.56
Providence Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $190.55 / $190.55	Professional		$190.55	$190.55	$190.55
United Facility/Professional Facility Modifier Low / Median / High Price $169.82 / $169.82 / $169.82	Facility		$169.82	$169.82	$169.82
United Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $199.53 / $204.17	Professional		$158.49	$199.53	$204.17