Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $50.00 / $113.50 / $118.50	Facility		$50.00	$113.50	$118.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $50.00 / $86.50	Professional		$50.00	$50.00	$86.50
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $100.00 / $187.52	Facility		$100.00	$100.00	$187.52
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $13.72 / $139.60 / $170.00	Professional		$13.72	$139.60	$170.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $85.00 / $85.00 / $85.00	Professional		$85.00	$85.00	$85.00
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
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $170.00 / $170.00 / $170.00	Professional		$170.00	$170.00	$170.00