| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medcost
| Facility | $43.56 | $46.42 | $124.88 |
Mod Sed Diff Phys/Qhp<5 Yrs
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medcost
| Facility | $43.56 | $46.42 | $124.88 |