| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medcost
| Facility | $59.06 | $80.39 | $117.66 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |
Medic-Physical Medic-Rehabilit
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medcost
| Facility | $59.06 | $80.39 | $117.66 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |