Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.06 / $102.05 / $168.05	Facility	26	$52.06	$102.05	$168.05
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $62.06 / $104.00 / $731.61	Facility	26	$62.06	$104.00	$731.61
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $45.26 / $113.58 / $1,678.39	Facility	26	$45.26	$113.58	$1,678.39
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $70.56 / $90.51 / $93.16	Facility	26	$70.56	$90.51	$93.16
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $62.06 / $62.06 / $62.61	Facility	26	$62.06	$62.06	$62.61
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $731.61 / $731.61 / $1,177.68	Facility	26	$731.61	$731.61	$1,177.68