| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Professional | AA | $271.45 | $271.45 | $271.45 |
Ambetter
| Professional | QX | $178.39 | $200.00 | $222.99 |
Ambetter
| Professional | QY | $220.00 | $222.99 | $240.00 |
Ambetter
| Professional | QZ | $122.16 | $290.85 | $579.30 |