| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Molina
| Facility | $1,071.52 | $1,071.52 | $1,148.15 |
Special Charges-Late Discharge, Medically Necessary
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Molina
| Facility | $1,071.52 | $1,071.52 | $1,148.15 |