| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $234.42 | $234.42 | $234.42 | |
Medica
| Professional | $66.07 | $66.07 | $66.07 | |
Molina
| Professional | $58.88 | $58.88 | $58.88 | |
Quartz
| Facility | $186.21 | $186.21 | $234.42 | |
Quartz
| Professional | $66.07 | $66.07 | $66.07 |