| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Molina
| Professional | $30.20 | $30.20 | $30.20 |
Implanted prosthetic device, payable only for inpatients who do not have inpatient coverage
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Molina
| Professional | $30.20 | $30.20 | $30.20 |