Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $101.90 / $137.09 / $215.48	Facility	26	$101.90	$137.09	$215.48
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $106.02 / $349.69 / $349.69	Facility	26	$106.02	$349.69	$349.69
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $65.34 / $111.85 / $198.94	Facility	26	$65.34	$111.85	$198.94
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $111.72 / $152.63 / $155.44	Facility	26	$111.72	$152.63	$155.44
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $105.10 / $105.10 / $106.02	Facility	26	$105.10	$105.10	$106.02
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,784.45 / $1,784.45 / $3,043.22	Facility	26	$1,784.45	$1,784.45	$3,043.22