Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $19.95 / $218.78 / $218.78	Facility		$19.95	$218.78	$218.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $15.14 / $19.95 / $218.78	Professional		$15.14	$19.95	$218.78
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $20.42 / $21.38 / $43.65	Facility		$20.42	$21.38	$43.65
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $15.14 / $19.95 / $25.12	Professional		$15.14	$19.95	$25.12
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $102.33 / $102.33 / $102.33	Facility		$102.33	$102.33	$102.33
Providence Facility/Professional Facility Modifier Low / Median / High Price $20.42 / $21.38 / $31.62	Facility		$20.42	$21.38	$31.62
Providence Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $79.43 / $79.43	Professional		$60.26	$79.43	$79.43