Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $220.41 / $297.42 / $463.77	Facility	26	$220.41	$297.42	$463.77
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $231.70 / $772.06 / $772.06	Facility	26	$231.70	$772.06	$772.06
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $141.47 / $235.69 / $408.78	Facility	26	$141.47	$235.69	$408.78
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $242.06 / $330.31 / $339.69	Facility	26	$242.06	$330.31	$339.69
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $229.22 / $229.22 / $231.70	Facility	26	$229.22	$229.22	$231.70