Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $151.36 / $208.93	Facility		$87.10	$151.36	$208.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $109.65	Professional		$87.10	$87.10	$109.65
Cigna Facility/Professional Facility Modifier Low / Median / High Price $83.18 / $87.10 / $87.10	Facility		$83.18	$87.10	$87.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $87.10	Professional		$87.10	$87.10	$87.10
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $436.52 / $436.52 / $436.52	Facility		$436.52	$436.52	$436.52
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $123.03 / $177.83	Facility		$87.10	$123.03	$177.83
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $87.10 / $95.50	Professional		$83.18	$87.10	$95.50
Molina Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $89.13	Professional		$87.10	$87.10	$89.13
Providence Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $125.89 / $275.42	Facility		$87.10	$125.89	$275.42
Providence Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $87.10	Professional		$87.10	$87.10	$87.10
United Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $87.10 / $87.10	Facility		$87.10	$87.10	$87.10
United Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $87.10	Professional		$87.10	$87.10	$87.10