| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medcost
| Professional | $39.00 | $221.00 | $260.00 | |
Oscar Health
| Professional | $325.20 | $393.60 | $452.60 | |
Wellcare
| Facility | $405.67 | $510.48 | $1,340.15 | |
Wellcare
| Professional | $1,969.00 | $1,969.00 | $1,969.00 |