Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $141.25 / $229.09	Facility		$114.82	$141.25	$229.09
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 / $478.63	Facility		$141.25	$251.19	$478.63
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $128.82 / $128.82	Professional		$128.82	$128.82	$128.82
United Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $141.25 / $141.25	Professional		$141.25	$141.25	$141.25