Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $138.04 / $165.96	Facility	26	$87.10	$138.04	$165.96
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $131.83 / $165.96	Professional	26	$114.82	$131.83	$165.96
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $125.89 / $128.82	Facility	26	$107.15	$125.89	$128.82
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $15.85 / $74.13 / $107.15	Facility	26	$15.85	$74.13	$107.15
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $2,290.87 / $2,290.87 / $2,290.87	Facility	26	$2,290.87	$2,290.87	$2,290.87