Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $690.00 / $690.00 / $690.00	Facility		$690.00	$690.00	$690.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.23 / $104.69 / $690.00	Professional		$102.23	$104.69	$690.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $62.16 / $62.16 / $62.16	Professional		$62.16	$62.16	$62.16
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 $104.69 / $104.69 / $225.08	Facility		$104.69	$104.69	$225.08
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $79,999.20 / $79,999.20 / $79,999.20	Facility		$79,999.20	$79,999.20	$79,999.20
Providence Facility/Professional Facility Modifier Low / Median / High Price $104.69 / $104.69 / $225.08	Facility		$104.69	$104.69	$225.08
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