| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Professional | QZ | $856.68 | $856.68 | $2,850.00 |
Lucent Health
| Facility | QK | $37.00 | $37.00 | $39.50 |
Lucent Health
| Facility | QX | $37.00 | $37.00 | $39.50 |
Lucent Health
| Facility | QY | $37.00 | $37.00 | $39.50 |