Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $50.00 / $50.00 / $50.00	Facility		$50.00	$50.00	$50.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $50.00 / $50.00	Professional		$50.00	$50.00	$50.00
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 $50.00 / $50.00 / $107.50	Facility		$50.00	$50.00	$107.50
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $122.86 / $122.86 / $79,999.20	Facility		$122.86	$122.86	$79,999.20
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $122.86 / $122.86 / $122.86	Professional		$122.86	$122.86	$122.86
Providence Facility/Professional Facility Modifier Low / Median / High Price $50.00 / $50.00 / $107.50	Facility		$50.00	$50.00	$107.50
Providence Facility/Professional Professional Modifier Low / Median / High Price $2,250,000.00 / $2,250,000.00 / $2,400,000.00	Professional		$2,250,000.00	$2,250,000.00	$2,400,000.00