| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Hally Health
| Facility | $150.00 | $150.00 | $150.00 | |
Oscar Health
| Facility | $436.82 | $5,866.66 | $10,133.29 | |
Wellmark
| Facility | $18,170.00 | $28,440.00 | $40,290.00 |
Patient Convenience Items-Other Convenience Items
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Hally Health
| Facility | $150.00 | $150.00 | $150.00 | |
Oscar Health
| Facility | $436.82 | $5,866.66 | $10,133.29 | |
Wellmark
| Facility | $18,170.00 | $28,440.00 | $40,290.00 |