| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Professional | $89.13 | $89.13 | $134.90 | |
Ambetter
| Professional | 26 | $35.48 | $38.02 | $53.70 |
United
| Professional | $95.50 | $141.25 | $218.78 | |
United
| Professional | 26 | $32.36 | $45.71 | $69.18 |
United
| Professional | TC | $58.88 | $87.10 | $165.96 |