Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $216.70 / $510.00 / $960.00	Professional	QZ	$216.70	$510.00	$960.00
Lucent Health Facility/Professional Facility Modifier QK Low / Median / High Price $37.00 / $39.50 / $52.00	Facility	QK	$37.00	$39.50	$52.00
Lucent Health Facility/Professional Facility Modifier QX Low / Median / High Price $37.00 / $39.50 / $52.00	Facility	QX	$37.00	$39.50	$52.00
Lucent Health Facility/Professional Facility Modifier QY Low / Median / High Price $37.00 / $39.50 / $52.00	Facility	QY	$37.00	$39.50	$52.00
Providence Facility/Professional Facility Modifier QK Low / Median / High Price $284.89 / $284.89 / $284.89	Facility	QK	$284.89	$284.89	$284.89
Providence Facility/Professional Facility Modifier QX Low / Median / High Price $284.89 / $284.89 / $284.89	Facility	QX	$284.89	$284.89	$284.89
Providence Facility/Professional Facility Modifier QY Low / Median / High Price $284.89 / $284.89 / $284.89	Facility	QY	$284.89	$284.89	$284.89