Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $138.91 / $138.91 / $151.41	Facility		$138.91	$138.91	$151.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $138.91 / $138.91 / $138.91	Professional		$138.91	$138.91	$138.91
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $108.35 / $198.90	Facility		$100.00	$108.35	$198.90
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1.00 / $40.04 / $171.81	Professional		$1.00	$40.04	$171.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $50.00 / $75.00	Professional		$50.00	$50.00	$75.00
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $218.40 / $79,999.20 / $79,999.20	Facility		$218.40	$79,999.20	$79,999.20
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $108.35 / $114.05 / $198.90	Facility		$108.35	$114.05	$198.90
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $117.05 / $117.05 / $128.76	Facility		$117.05	$117.05	$128.76
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $40.21 / $40.21 / $40.21	Professional		$40.21	$40.21	$40.21