| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Professional | AA | $100.25 | $100.25 | $100.25 |
Ambetter
| Professional | QY | $60.15 | $60.15 | $60.15 |
Anes Perq Img Dstrj Px Nulyt Agt Spi/Sp Lmbr/Sac
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Professional | AA | $100.25 | $100.25 | $100.25 |
Ambetter
| Professional | QY | $60.15 | $60.15 | $60.15 |