Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $138.04 / $190.55 / $309.03	Facility	26	$138.04	$190.55	$309.03
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $97.72 / $154.88 / $213.80	Facility	26	$97.72	$154.88	$213.80
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $138.04 / $165.96 / $173.78	Facility	26	$138.04	$165.96	$173.78
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $114.82 / $114.82	Facility	26	$114.82	$114.82	$114.82