| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Professional | $64.57 | $64.57 | $64.57 | |
Ambetter
| Professional | 26 | $19.95 | $19.95 | $28.84 |
United
| Professional | $57.54 | $83.18 | $158.49 | |
United
| Professional | 26 | $15.14 | $20.89 | $28.18 |
United
| Professional | TC | $41.69 | $61.66 | $134.90 |