Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $131.83 / $165.96	Facility	26	$104.71	$131.83	$165.96
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $109.65 / $134.90	Professional	26	$52.48	$109.65	$134.90
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $158.49 / $204.17	Facility	26	$104.71	$158.49	$204.17
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $131.83 / $309.03	Facility	26	$87.10	$131.83	$309.03