| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medcost
| Facility | $1,000.00 | $1,000.00 | $1,000.00 | |
Wellcare
| Facility | $100.00 | $100.00 | $100.00 | |
Wellcare
| Professional | $1,288.04 | $1,288.04 | $1,288.04 |
Unspecified Restorative Procedure By Report
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medcost
| Facility | $1,000.00 | $1,000.00 | $1,000.00 | |
Wellcare
| Facility | $100.00 | $100.00 | $100.00 | |
Wellcare
| Professional | $1,288.04 | $1,288.04 | $1,288.04 |