Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $100.00 / $114.82	Professional		$100.00	$100.00	$114.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $25.70 / $33.88	Professional	26	$19.05	$25.70	$33.88
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $81.28 / $81.28	Professional	TC	$81.28	$81.28	$81.28
BCBS Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $72.44 / $95.50	Professional		$72.44	$72.44	$95.50
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $21.38 / $28.18	Professional	26	$21.38	$21.38	$28.18
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $51.29 / $67.61	Professional	TC	$51.29	$51.29	$67.61
CareSource Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $109.65 / $158.49	Professional		$46.77	$109.65	$158.49
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $114.82 / $131.83	Professional		$114.82	$114.82	$131.83
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $33.11 / $38.02	Professional	26	$29.51	$33.11	$38.02
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $93.33 / $93.33	Professional	TC	$93.33	$93.33	$93.33
United Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $109.65 / $158.49	Professional		$66.07	$109.65	$158.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $22.91 / $38.02	Professional	26	$18.20	$22.91	$38.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $83.18 / $128.82	Professional	TC	$47.86	$83.18	$128.82