| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Facility | $58.78 | $130.52 | $253.28 |
Other Therapeutic Services (see also 095X, an extension of 094X)-General Classification
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Facility | $58.78 | $130.52 | $253.28 |