Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $104.71 / $104.71	Professional		$104.71	$104.71	$104.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $44.67 / $91.20	Professional		$35.48	$44.67	$91.20
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $19.95 / $27.54 / $51.29	Facility		$19.95	$27.54	$51.29
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $28.18 / $53.70	Professional		$19.95	$28.18	$53.70
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 $37.15 / $44.67 / $44.67	Facility		$37.15	$44.67	$44.67
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $29.51 / $29.51 / $29.51	Facility		$29.51	$29.51	$29.51
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $52.48 / $67.61	Professional		$30.90	$52.48	$67.61
United Facility/Professional Professional Modifier Low / Median / High Price $22.39 / $31.62 / $58.88	Professional		$22.39	$31.62	$58.88