Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.75 / $153.00 / $240.84	Facility	26	$118.75	$153.00	$240.84
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $117.33 / $164.34 / $396.63	Facility	26	$117.33	$164.34	$396.63
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $85.87 / $180.52 / $237.95	Facility	26	$85.87	$180.52	$237.95
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $141.93 / $170.18 / $176.12	Facility	26	$141.93	$170.18	$176.12
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $117.33 / $117.33 / $118.36	Facility	26	$117.33	$117.33	$118.36