Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.07 / $167.40 / $275.05	Facility	26	$85.07	$167.40	$275.05
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $173.00 / $352.14 / $352.14	Facility	26	$173.00	$352.14	$352.14
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $76.66 / $171.30 / $8,105.48	Facility	26	$76.66	$171.30	$8,105.48
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $124.30 / $149.85 / $153.43	Facility	26	$124.30	$149.85	$153.43
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $102.38 / $102.38 / $103.28	Facility	26	$102.38	$102.38	$103.28
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $5,551.62 / $5,551.62 / $8,401.03	Facility	26	$5,551.62	$5,551.62	$8,401.03