Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $123.03 / $162.18 / $389.05	Facility	26	$123.03	$162.18	$389.05
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $138.04 / $181.97 / $371.54	Facility	26	$138.04	$181.97	$371.54
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $112.20 / $138.04 / $275.42	Facility	26	$112.20	$138.04	$275.42
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $93.33 / $120.23	Facility	26	$93.33	$93.33	$120.23