| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
DeanCare
| Facility | $1,000.00 | $1,000.00 | $1,000.00 | |
Medica
| Facility | $1,000.00 | $1,000.00 | $1,000.00 | |
Molina
| Professional | $50.00 | $55.00 | $85.00 | |
Prevea360
| Facility | $1,000.00 | $1,000.00 | $1,000.00 |