Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $239.88 / $239.88 / $3,801.89	Facility		$239.88	$239.88	$3,801.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $239.88 / $323.59	Professional		$173.78	$239.88	$323.59
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $134.90 / $245.47	Professional		$134.90	$134.90	$245.47
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $83.18 / $104.71 / $263.03	Facility		$83.18	$104.71	$263.03
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $316.23 / $478.63	Professional		$194.98	$316.23	$478.63
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $97.72 / $363.08 / $501.19	Facility		$97.72	$363.08	$501.19
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $190.55 / $363.08	Professional		$151.36	$190.55	$363.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $147.91 / $147.91	Professional		$147.91	$147.91	$147.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $194.98 / $371.54	Professional		$162.18	$194.98	$371.54
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $1,230.27 / $1,230.27 / $1,230.27	Facility		$1,230.27	$1,230.27	$1,230.27
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,230.27 / $1,584.89 / $1,584.89	Professional		$1,230.27	$1,584.89	$1,584.89
Molina Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $54.95 / $109.65	Professional		$54.95	$54.95	$109.65
Providence Facility/Professional Facility Modifier Low / Median / High Price $186.21 / $239.88 / $346.74	Facility		$186.21	$239.88	$346.74
Providence Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $112.20 / $177.83	Professional		$112.20	$112.20	$177.83
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $186.21 / $245.47	Professional		$181.97	$186.21	$245.47
United Facility/Professional Facility Modifier Low / Median / High Price $338.84 / $354.81 / $549.54	Facility		$338.84	$354.81	$549.54
United Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $208.93 / $616.60	Professional		$147.91	$208.93	$616.60