| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $100.00 | $100.00 | $100.00 | |
Molina
| Professional | $50.00 | $58.40 | $85.00 | |
Quartz
| Professional | $5,900.00 | $5,900.00 | $5,900.00 | |
Quartz
| Facility | $65.00 | $65.00 | $100.00 |