Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $200.00 / $200.00 / $322.00	Facility		$200.00	$200.00	$322.00
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $90.25 / $90.25 / $90.25	Facility		$90.25	$90.25	$90.25
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $10.85 / $35.26 / $584.24	Facility		$10.85	$35.26	$584.24