| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Facility | $177.83 | $177.83 | $354.81 | |
Hally Health
| Facility | $100.00 | $199.53 | $346.74 |
Professional Fees (Extension of 096X and 097X)-Emergency Room
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Facility | $177.83 | $177.83 | $354.81 | |
Hally Health
| Facility | $100.00 | $199.53 | $346.74 |