Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.86 / $141.25 / $229.09	Facility	26	$75.86	$141.25	$229.09
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $81.28 / $141.25 / $177.83	Facility	26	$81.28	$141.25	$177.83
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $131.83 / $141.25	Facility	26	$109.65	$131.83	$141.25
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $93.33 / $95.50	Facility	26	$93.33	$93.33	$95.50