| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Molina
| Facility | $64.57 | $75.86 | $3,715.35 |
Special Charges-Late Discharge, Medically Necessary
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Molina
| Facility | $64.57 | $75.86 | $3,715.35 |