Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $173.78 / $489.78	Facility		$87.10	$173.78	$489.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $75.86 / $131.83	Professional		$74.13	$75.86	$131.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $74.13 / $74.13	Professional		$74.13	$74.13	$74.13
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $74.13 / $89.13 / $186.21	Facility		$74.13	$89.13	$186.21
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $93.33 / $186.21	Professional		$74.13	$93.33	$186.21
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $74.13 / $158.49 / $245.47	Facility		$74.13	$158.49	$245.47
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $134.90 / $134.90	Professional		$112.20	$134.90	$134.90
Providence Facility/Professional Facility Modifier Low / Median / High Price $74.13 / $102.33 / $181.97	Facility		$74.13	$102.33	$181.97
Providence Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $74.13 / $104.71	Professional		$74.13	$74.13	$104.71
United Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $112.20 / $208.93	Professional		$74.13	$112.20	$208.93