| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Hally Health
| Facility | $150.00 | $150.00 | $150.00 | |
Oscar Health
| Facility | $362.92 | $1,378.61 | $2,381.23 | |
Wellmark
| Facility | $18,170.00 | $28,440.00 | $40,290.00 |
Other Diagnostic Services - Other Diagnostic Services
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Hally Health
| Facility | $150.00 | $150.00 | $150.00 | |
Oscar Health
| Facility | $362.92 | $1,378.61 | $2,381.23 | |
Wellmark
| Facility | $18,170.00 | $28,440.00 | $40,290.00 |