| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Facility | $122.12 | $122.35 | $158.12 | |
United
| Facility | $5,069.00 | $5,069.00 | $5,069.00 |
Preventive Care Services-General Classification
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Facility | $122.12 | $122.35 | $158.12 | |
United
| Facility | $5,069.00 | $5,069.00 | $5,069.00 |