Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $213.80 / $354.81	Facility	26	$109.65	$213.80	$354.81
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $112.20 / $169.82 / $251.19	Facility	26	$112.20	$169.82	$251.19
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $162.18 / $194.98 / $199.53	Facility	26	$162.18	$194.98	$199.53
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $131.83 / $131.83 / $134.90	Facility	26	$131.83	$131.83	$134.90