| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Facility | $503.41 | $503.41 | $503.41 |
Medical/Surgical Supplies and Devices-Other Supplies/Devices
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Facility | $503.41 | $503.41 | $503.41 |