| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Professional | QZ | $549.54 | $1,023.29 | $2,238.72 |
Lucent Health
| Facility | QK | $52.48 | $52.48 | $52.48 |
Lucent Health
| Facility | QX | $52.48 | $52.48 | $52.48 |
Lucent Health
| Facility | QY | $52.48 | $52.48 | $52.48 |