Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $562.34 / $562.34	Facility		$128.82	$562.34	$562.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $128.82	Professional		$87.10	$87.10	$128.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $87.10	Professional		$87.10	$87.10	$87.10
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $104.71 / $218.78	Facility		$87.10	$104.71	$218.78
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $109.65 / $218.78	Professional		$87.10	$109.65	$218.78
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $134.90 / $208.93	Facility		$87.10	$134.90	$208.93
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $114.82 / $114.82	Professional		$95.50	$114.82	$114.82
Providence Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $112.20 / $169.82	Facility		$87.10	$112.20	$169.82
Providence Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $158.49	Professional		$87.10	$87.10	$158.49
United Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $131.83 / $245.47	Professional		$87.10	$131.83	$245.47