Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $57.54 / $57.54	Professional		$57.54	$57.54	$57.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $141.25 / $281.84	Professional		$112.20	$141.25	$281.84
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $64.57 / $87.10 / $165.96	Facility		$64.57	$87.10	$165.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $89.13 / $173.78	Professional		$64.57	$89.13	$173.78
Molina Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $44.67 / $50.12	Professional		$33.11	$44.67	$50.12
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $117.49 / $144.54 / $144.54	Facility		$117.49	$144.54	$144.54
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $95.50 / $95.50 / $95.50	Facility		$95.50	$95.50	$95.50
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $169.82 / $213.80	Professional		$100.00	$169.82	$213.80
United Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $100.00 / $186.21	Professional		$67.61	$100.00	$186.21