| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $89.13 | $89.13 | $89.13 | |
Medica
| Professional | $7.59 | $7.59 | $7.59 | |
Molina
| Professional | $58.88 | $58.88 | $58.88 | |
Quartz
| Facility | $60.26 | $60.26 | $89.13 | |
Quartz
| Professional | $7.59 | $7.59 | $7.59 |