Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $295.12 / $302.00 / $707.95	Facility		$295.12	$302.00	$707.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $302.00 / $363.08	Professional		$295.12	$302.00	$363.08
BCBS Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $309.03 / $309.03	Professional		$309.03	$309.03	$309.03
Cigna Facility/Professional Facility Modifier Low / Median / High Price $309.03 / $309.03 / $309.03	Facility		$309.03	$309.03	$309.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $309.03 / $309.03	Professional		$309.03	$309.03	$309.03
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $1,096.48 / $1,096.48 / $1,096.48	Facility		$1,096.48	$1,096.48	$1,096.48
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,659.59 / $1,659.59 / $1,659.59	Professional		$1,659.59	$1,659.59	$1,659.59
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $295.12 / $363.08 / $707.95	Facility		$295.12	$363.08	$707.95
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $302.00 / $309.03	Professional		$295.12	$302.00	$309.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $89.13 / $89.13	Professional		$30.20	$89.13	$89.13
Providence Facility/Professional Facility Modifier Low / Median / High Price $302.00 / $363.08 / $977.24	Facility		$302.00	$363.08	$977.24
Providence Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $309.03 / $309.03	Professional		$309.03	$309.03	$309.03
United Facility/Professional Facility Modifier Low / Median / High Price $177.83 / $275.42 / $275.42	Facility		$177.83	$275.42	$275.42
United Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $302.00 / $302.00	Professional		$302.00	$302.00	$302.00
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $46.77 / $46.77	Professional		$46.77	$46.77	$46.77