Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $141.25 / $660.69	Facility		$128.82	$141.25	$660.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $141.25 / $239.88	Professional		$114.82	$141.25	$239.88
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $141.25 / $141.25	Facility		$141.25	$141.25	$141.25
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $251.19 / $426.58	Facility		$141.25	$251.19	$426.58
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $128.82 / $169.82	Professional		$128.82	$128.82	$169.82
United Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $204.17 / $204.17	Professional		$204.17	$204.17	$204.17