| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Professional | QZ | $138.66 | $138.66 | $138.66 |
Anes Perq Img Dstrj Px Nulyt Agt Spi/Sp Crv/Thrc
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Professional | QZ | $138.66 | $138.66 | $138.66 |