| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Molina
| Professional | $50.00 | $55.00 | $70.00 |
Prescrl Fuse W/O Instr L5/S
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Molina
| Professional | $50.00 | $55.00 | $70.00 |