| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $1,288.25 | $1,288.25 | $1,288.25 | |
Molina
| Facility | $1,174.90 | $2,398.83 | $5,011.87 | |
Quartz
| Facility | $13,803.84 | $13,803.84 | $13,803.84 | |
United
| Facility | $870.96 | $1,047.13 | $1,862.09 |