Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $123.03 / $208.93	Facility	26	$63.10	$123.03	$208.93
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $109.65 / $4,897.79	Facility	26	$63.10	$109.65	$4,897.79
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $109.65 / $114.82	Facility	26	$91.20	$109.65	$114.82
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $74.13 / $74.13 / $75.86	Facility	26	$74.13	$74.13	$75.86
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $3,388.44 / $3,388.44 / $3,388.44	Facility	26	$3,388.44	$3,388.44	$3,388.44