| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Molina
| Professional | $1,915.99 | $1,915.99 | $2,094.26 |
Plmt Xtn Prosth Evasc Rpr Arysm/Dsj 1St Vsl
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Molina
| Professional | $1,915.99 | $1,915.99 | $2,094.26 |