Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $204.17 / $331.13 / $426.58	Facility	26	$204.17	$331.13	$426.58
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $134.90 / $223.87 / $363.08	Facility	26	$134.90	$223.87	$363.08
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $257.04 / $309.03 / $316.23	Facility	26	$257.04	$309.03	$316.23
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $208.93 / $208.93 / $208.93	Facility	26	$208.93	$208.93	$208.93