| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medcost
| Professional | $91.00 | $129.00 | $129.00 |
Domicil/Rest Home New Pt Visit Mod Sever 30 Min
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medcost
| Professional | $91.00 | $129.00 | $129.00 |