Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $95.50 / $123.03 / $213.80	Facility	26	$95.50	$123.03	$213.80
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $117.49 / $158.49 / $239.88	Facility	26	$117.49	$158.49	$239.88
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $141.25 / $181.97	Facility	26	$114.82	$141.25	$181.97
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $95.50 / $95.50 / $95.50	Facility	26	$95.50	$95.50	$95.50