| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
United
| Facility | $4,976.00 | $4,976.00 | $4,976.00 |
Preventive Care Services - General
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
United
| Facility | $4,976.00 | $4,976.00 | $4,976.00 |