| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Molina
| Professional | $201.56 | $201.56 | $201.56 | |
Providence
| Facility | $142.63 | $142.63 | $142.63 | |
Providence
| Professional | $150.47 | $171.16 | $198.26 |
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Molina
| Professional | $201.56 | $201.56 | $201.56 | |
Providence
| Facility | $142.63 | $142.63 | $142.63 | |
Providence
| Professional | $150.47 | $171.16 | $198.26 |