| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Facility | $366.00 | $366.00 | $966.00 |
Other Diagnostic Services-Other Diagnostic Service
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Facility | $366.00 | $366.00 | $966.00 |