| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medcost
| Professional | $89.00 | $119.00 | $119.00 |
Indiv Phys Supvj Home/Dom/R-Home Mo 15-29 Min
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medcost
| Professional | $89.00 | $119.00 | $119.00 |