Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.28 / $123.50 / $504.53	Facility	26	$63.28	$123.50	$504.53
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $116.75 / $251.32 / $251.32	Facility	26	$116.75	$251.32	$251.32
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $55.80 / $123.12 / $4,890.87	Facility	26	$55.80	$123.12	$4,890.87
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $90.75 / $109.83 / $115.24	Facility	26	$90.75	$109.83	$115.24
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $74.75 / $74.75 / $75.41	Facility	26	$74.75	$74.75	$75.41
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $3,403.52 / $3,403.52 / $5,427.71	Facility	26	$3,403.52	$3,403.52	$5,427.71