| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $100.00 | $100.00 | $100.00 | |
Molina
| Professional | $50.12 | $64.57 | $85.11 | |
Quartz
| Professional | $5,888.44 | $5,888.44 | $5,888.44 | |
Quartz
| Facility | $64.57 | $64.57 | $100.00 |