| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Molina
| Facility | $3,289.38 | $3,289.38 | $3,289.38 |
Professional Fees (Extension of 096X and 097X)-Clinic
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Molina
| Facility | $3,289.38 | $3,289.38 | $3,289.38 |