Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $79.43 / $79.43	Professional		$67.61	$79.43	$79.43
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $19.05 / $25.12	Professional	26	$19.05	$19.05	$25.12
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $37.15	Professional		$32.36	$33.11	$37.15
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $33.11 / $38.90 / $40.74	Facility	26	$33.11	$38.90	$40.74
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $33.88 / $43.65	Professional	26	$24.55	$33.88	$43.65
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $100.00 / $117.49	Professional	TC	$70.79	$100.00	$117.49
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $26.92 / $28.18	Facility	26	$26.92	$26.92	$28.18
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $158.49 / $218.78	Professional		$102.33	$158.49	$218.78
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $43.65 / $60.26	Professional	26	$28.18	$43.65	$60.26
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $117.49 / $158.49	Professional	TC	$75.86	$117.49	$158.49
United Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $102.33 / $199.53	Professional		$85.11	$102.33	$199.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $26.30 / $50.12	Professional	26	$21.38	$26.30	$50.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $75.86 / $144.54	Professional	TC	$61.66	$75.86	$144.54