Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $38.15 / $99.75 / $123.95	Facility		$38.15	$99.75	$123.95
Providence Facility/Professional Professional Modifier Low / Median / High Price $75.00 / $80.00 / $80.00	Professional		$75.00	$80.00	$80.00