| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medcost
| Facility | $837.62 | $962.84 | $2,139.13 | |
Oscar Health
| Professional | $891.60 | $1,015.70 | $1,311.60 | |
Wellcare
| Facility | $55.00 | $1,533.35 | $2,218.83 | |
Wellcare
| Professional | $3,219.89 | $4,156.21 | $4,156.21 |