| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Facility | $295.12 | $295.12 | $295.12 |
Professional Fees (Extension of 096X and 097X)-Emergency Room
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Facility | $295.12 | $295.12 | $295.12 |