Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $338.13 / $433.40 / $714.00	Professional	QZ	$338.13	$433.40	$714.00
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 $447.70 / $447.70 / $447.70	Facility	QK	$447.70	$447.70	$447.70
Providence Facility/Professional Facility Modifier QX Low / Median / High Price $447.70 / $447.70 / $447.70	Facility	QX	$447.70	$447.70	$447.70
Providence Facility/Professional Facility Modifier QY Low / Median / High Price $447.70 / $447.70 / $447.70	Facility	QY	$447.70	$447.70	$447.70