Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $104.69 / $104.69 / $104.69	Facility		$104.69	$104.69	$104.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.23 / $104.69 / $104.69	Professional		$102.23	$104.69	$104.69
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $57.40 / $104.69 / $178.60	Facility		$57.40	$104.69	$178.60
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $270.97 / $270.97 / $270.97	Professional		$270.97	$270.97	$270.97
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $189.33 / $189.33 / $189.33	Facility		$189.33	$189.33	$189.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.00 / $30.00 / $30.00	Professional		$30.00	$30.00	$30.00
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
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $50.88 / $67.42 / $143.10	Facility		$50.88	$67.42	$143.10
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $25.32 / $25.32 / $25.32	Professional		$25.32	$25.32	$25.32