Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $397.80 / $1,173.00 / $1,426.00	Professional	QZ	$397.80	$1,173.00	$1,426.00
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 $651.20 / $651.20 / $651.20	Facility	QK	$651.20	$651.20	$651.20
Providence Facility/Professional Facility Modifier QX Low / Median / High Price $651.20 / $651.20 / $651.20	Facility	QX	$651.20	$651.20	$651.20
Providence Facility/Professional Facility Modifier QY Low / Median / High Price $651.20 / $651.20 / $651.20	Facility	QY	$651.20	$651.20	$651.20