Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $109.65 / $123.03	Professional		$109.65	$109.65	$123.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $102.33 / $123.03	Professional		$97.72	$102.33	$123.03
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $537.03 / $537.03	Professional		$537.03	$537.03	$537.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $44.67 / $75.86	Professional		$32.36	$44.67	$75.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $36.31 / $51.29 / $63.10	Facility		$36.31	$51.29	$63.10
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $190.55 / $190.55 / $194.98	Facility		$190.55	$190.55	$194.98
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $323.59 / $575.44	Professional		$194.98	$323.59	$575.44
United Facility/Professional Facility Modifier Low / Median / High Price $223.87 / $302.00 / $371.54	Facility		$223.87	$302.00	$371.54
United Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $338.84 / $851.14	Professional		$199.53	$338.84	$851.14