Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $5.00 / $5.00 / $5.00	Facility		$5.00	$5.00	$5.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $5.00 / $5.00 / $5.00	Professional		$5.00	$5.00	$5.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $31.24 / $31.24 / $31.24	Professional		$31.24	$31.24	$31.24
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $150.00 / $175.00 / $194.25	Professional		$150.00	$175.00	$194.25
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $5.00 / $5.00 / $10.75	Facility		$5.00	$5.00	$10.75
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $614.29 / $614.29 / $79,999.20	Facility		$614.29	$614.29	$79,999.20
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $614.29 / $614.29 / $614.29	Professional		$614.29	$614.29	$614.29
Providence Facility/Professional Facility Modifier Low / Median / High Price $5.00 / $5.00 / $10.75	Facility		$5.00	$5.00	$10.75
Providence Facility/Professional Professional Modifier Low / Median / High Price $31.24 / $31.24 / $2,400,000.00	Professional		$31.24	$31.24	$2,400,000.00