Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $426.58 / $676.08	Facility		$141.25	$426.58	$676.08
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $123.03 / $123.03	Professional		$123.03	$123.03	$123.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $44.67 / $50.12	Professional		$32.36	$44.67	$50.12
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $19.50 / $28.84 / $81.28	Facility		$19.50	$28.84	$81.28
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $72.44 / $72.44 / $77.62	Facility		$72.44	$72.44	$77.62
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $109.65 / $154.88	Professional		$72.44	$109.65	$154.88
United Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $85.11 / $134.90	Professional		$56.23	$85.11	$134.90