| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Molina
| Professional | $130.28 | $130.28 | $142.40 |
Prolonged Svc I/P Or Obs Setting 1st Hour
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Molina
| Professional | $130.28 | $130.28 | $142.40 |