| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Facility | $4,490.93 | $4,490.93 | $4,490.93 |
Radiology-Diagnostic Other
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Facility | $4,490.93 | $4,490.93 | $4,490.93 |