| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Professional | $8,526.91 | $8,526.91 | $8,526.91 | |
Molina
| Professional | $58.40 | $58.40 | $58.40 | |
Quartz
| Facility | $2,636.04 | $2,636.04 | $2,636.04 | |
Quartz
| Professional | $4,993.39 | $4,993.39 | $8,526.91 |