Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $66.56 / $319.95 / $13,750.00	Facility		$66.56	$319.95	$13,750.00
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $55.00 / $182.61 / $422.95	Facility		$55.00	$182.61	$422.95
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $54.45 / $108.50 / $297.60	Facility		$54.45	$108.50	$297.60
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $137.55 / $236.18 / $283.41	Facility		$137.55	$236.18	$283.41
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $193.31 / $193.31 / $200.23	Facility		$193.31	$193.31	$200.23
United Facility/Professional Facility Modifier Low / Median / High Price $414.00 / $666.00 / $6,216.00	Facility		$414.00	$666.00	$6,216.00