Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.40 / $114.76 / $203.02	Facility	26	$58.40	$114.76	$203.02
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $123.00 / $246.45 / $246.45	Facility	26	$123.00	$246.45	$246.45
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $53.50 / $117.49 / $8,105.48	Facility	26	$53.50	$117.49	$8,105.48
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $85.17 / $101.88 / $112.56	Facility	26	$85.17	$101.88	$112.56
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $70.67 / $70.67 / $70.84	Facility	26	$70.67	$70.67	$70.84
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