| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Facility | $162.82 | $162.82 | $162.82 | |
Hally Health
| Facility | $100.00 | $120.00 | $345.40 |
Professional Fees - Clinic
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Facility | $162.82 | $162.82 | $162.82 | |
Hally Health
| Facility | $100.00 | $120.00 | $345.40 |