| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Facility | $2,490.00 | $5,283.12 | $7,717.10 |
Lithotripsy - General Classification
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Facility | $2,490.00 | $5,283.12 | $7,717.10 |