Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $281.84 / $691.83 / $1,584.89	Facility		$281.84	$691.83	$1,584.89
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $281.84 / $501.19 / $1,258.93	Facility		$281.84	$501.19	$1,258.93
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $407.38 / $602.56 / $645.65	Facility		$407.38	$602.56	$645.65
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $446.68 / $446.68 / $446.68	Facility		$446.68	$446.68	$446.68
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $575.44 / $891.25 / $1,698.24	Facility		$575.44	$891.25	$1,698.24
United Facility/Professional Facility Modifier Low / Median / High Price $602.56 / $812.83 / $2,041.74	Facility		$602.56	$812.83	$2,041.74