| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medcost
| Facility | $679.00 | $919.90 | $1,389.87 | |
Medcost
| Professional | $919.90 | $919.90 | $919.90 | |
Wellcare
| Facility | $55.00 | $2,089.85 | $5,522.95 | |
Wellcare
| Professional | $4,977.08 | $4,977.08 | $4,977.08 |