| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Facility | $48.34 | $158.63 | $401.07 | |
Anthem BCBS
| Facility | $256.50 | $285.00 | $584.00 |
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 | $48.34 | $158.63 | $401.07 | |
Anthem BCBS
| Facility | $256.50 | $285.00 | $584.00 |