Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $121.31 / $455.58 / $13,750.00	Facility		$121.31	$455.58	$13,750.00
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $55.00 / $800.18 / $800.18	Facility		$55.00	$800.18	$800.18
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $90.18 / $168.93 / $407.57	Facility		$90.18	$168.93	$407.57
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $178.80 / $321.64 / $379.89	Facility		$178.80	$321.64	$379.89
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $259.12 / $259.12 / $264.10	Facility		$259.12	$259.12	$264.10
United Facility/Professional Facility Modifier Low / Median / High Price $414.00 / $666.00 / $6,216.00	Facility		$414.00	$666.00	$6,216.00