| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Facility | $18.87 | $18.87 | $18.87 |
Medical/Surgical Supplies Extension of 027X-Supplies Incident to Other DX Services
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Facility | $18.87 | $18.87 | $18.87 |