| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Professional | $2,197.36 | $2,197.36 | $2,197.36 | |
Molina
| Professional | $50.00 | $50.00 | $70.00 | |
Quartz
| Facility | $2,197.36 | $2,197.36 | $2,197.36 | |
Quartz
| Professional | $833.79 | $833.79 | $2,197.36 |