| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medcost
| Facility | $408.67 | $583.82 | $583.82 | |
Medcost
| Professional | $583.82 | $583.82 | $583.82 | |
Wellcare
| Facility | $1,395.64 | $1,568.00 | $87,969.10 | |
Wellcare
| Professional | $3,834.43 | $3,834.43 | $3,834.43 |