| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Hally Health
| Facility | $150.00 | $150.00 | $150.00 | |
Oscar Health
| Facility | $8,111.41 | $28,851.60 | $49,834.56 | |
Wellmark
| Facility | $18,170.00 | $28,440.00 | $40,290.00 |
Acquisition of Body Components-General Classification
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Hally Health
| Facility | $150.00 | $150.00 | $150.00 | |
Oscar Health
| Facility | $8,111.41 | $28,851.60 | $49,834.56 | |
Wellmark
| Facility | $18,170.00 | $28,440.00 | $40,290.00 |