Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $255.00 / $255.00 / $255.00	Professional	QZ	$255.00	$255.00	$255.00
Lucent Health Facility/Professional Facility Modifier QK Low / Median / High Price $37.00 / $37.00 / $39.50	Facility	QK	$37.00	$37.00	$39.50
Lucent Health Facility/Professional Facility Modifier QX Low / Median / High Price $37.00 / $37.00 / $39.50	Facility	QX	$37.00	$37.00	$39.50
Lucent Health Facility/Professional Facility Modifier QY Low / Median / High Price $37.00 / $37.00 / $39.50	Facility	QY	$37.00	$37.00	$39.50
Providence Facility/Professional Facility Modifier QK Low / Median / High Price $162.80 / $162.80 / $162.80	Facility	QK	$162.80	$162.80	$162.80
Providence Facility/Professional Facility Modifier QX Low / Median / High Price $162.80 / $162.80 / $162.80	Facility	QX	$162.80	$162.80	$162.80
Providence Facility/Professional Facility Modifier QY Low / Median / High Price $162.80 / $162.80 / $162.80	Facility	QY	$162.80	$162.80	$162.80