| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
ConnectiCare
| Facility | $125.00 | $125.00 | $125.00 |
Medical Social Services - Visit Charge
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
ConnectiCare
| Facility | $125.00 | $125.00 | $125.00 |