| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Facility | $166.88 | $166.88 | $166.88 | |
Anthem BCBS
| Facility | $256.50 | $285.00 | $584.00 |
Other Therapeutic Services (see also 095X, an extension of 094X)-Other Therapeutic Services
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Facility | $166.88 | $166.88 | $166.88 | |
Anthem BCBS
| Facility | $256.50 | $285.00 | $584.00 |