| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Facility | $155.52 | $793.86 | $4,293.96 | |
Pacific Source
| Facility | $79,999.20 | $79,999.20 | $79,999.20 |
Medical/Surgical Supplies and Devices-Other Implants
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Facility | $155.52 | $793.86 | $4,293.96 | |
Pacific Source
| Facility | $79,999.20 | $79,999.20 | $79,999.20 |