Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $173.78 / $213.80 / $6,309.57	Facility		$173.78	$213.80	$6,309.57
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $199.53 / $269.15 / $275.42	Facility		$199.53	$269.15	$275.42
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $181.97 / $933.25	Facility		$141.25	$181.97	$933.25
United Facility/Professional Facility Modifier Low / Median / High Price $1,230.27 / $1,380.38 / $2,137.96	Facility		$1,230.27	$1,380.38	$2,137.96