| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
CareSource
| Facility | $202.50 | $202.50 | $202.50 | |
CareSource
| Professional | $202.50 | $253.13 | $324.00 |
Ffs - Not Available
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
CareSource
| Facility | $202.50 | $202.50 | $202.50 | |
CareSource
| Professional | $202.50 | $253.13 | $324.00 |