| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Oscar Health
| Professional | $89.50 | $89.50 | $89.50 |
Auditor Evoke Potent Limit
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Oscar Health
| Professional | $89.50 | $89.50 | $89.50 |