Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $286.00 / $1,280.00 / $1,520.00	Professional	QZ	$286.00	$1,280.00	$1,520.00
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 $366.30 / $366.30 / $366.30	Facility	QK	$366.30	$366.30	$366.30
Providence Facility/Professional Facility Modifier QX Low / Median / High Price $366.30 / $366.30 / $366.30	Facility	QX	$366.30	$366.30	$366.30
Providence Facility/Professional Facility Modifier QY Low / Median / High Price $366.30 / $366.30 / $366.30	Facility	QY	$366.30	$366.30	$366.30