Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $203.55 / $203.55 / $203.55	Professional		$203.55	$203.55	$203.55
Cigna Facility/Professional Facility Modifier Low / Median / High Price $109.44 / $109.44 / $109.44	Facility		$109.44	$109.44	$109.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.44 / $109.44 / $154.86	Professional		$109.44	$109.44	$154.86
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $130.11 / $203.55 / $291.08	Facility		$130.11	$203.55	$291.08
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $109.44 / $109.44 / $142.27	Professional		$109.44	$109.44	$142.27
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $400.22 / $2,668.80 / $3,669.60	Facility		$400.22	$2,668.80	$3,669.60
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,384.44 / $1,834.80 / $2,001.60	Professional		$1,384.44	$1,834.80	$2,001.60
Providence Facility/Professional Facility Modifier Low / Median / High Price $109.44 / $203.55 / $1,834.80	Facility		$109.44	$203.55	$1,834.80
Providence Facility/Professional Professional Modifier Low / Median / High Price $109.44 / $314.81 / $840.00	Professional		$109.44	$314.81	$840.00
United Facility/Professional Professional Modifier Low / Median / High Price $164.16 / $164.16 / $328.32	Professional		$164.16	$164.16	$328.32