Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $141.25 / $165.96	Facility	26	$87.10	$141.25	$165.96
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $138.04 / $165.96	Professional	26	$120.23	$138.04	$165.96
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $128.82 / $131.83	Facility	26	$107.15	$128.82	$131.83
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $16.22 / $75.86 / $107.15	Facility	26	$16.22	$75.86	$107.15
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $3,311.31 / $3,311.31 / $3,311.31	Facility	26	$3,311.31	$3,311.31	$3,311.31