| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Professional | $4,298.21 | $4,298.21 | $4,298.21 | |
Molina
| Professional | $58.40 | $58.40 | $58.40 | |
Quartz
| Facility | $1,328.85 | $1,328.85 | $1,328.85 | |
Quartz
| Professional | $2,517.02 | $2,517.02 | $4,298.21 |