| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Professional | QZ | $912.01 | $977.24 | $2,951.21 |
Wellcare
| Facility | QK | $52.48 | $52.48 | $52.48 |
Wellcare
| Facility | QX | $52.48 | $52.48 | $52.48 |
Wellcare
| Facility | QY | $52.48 | $52.48 | $52.48 |