| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $117.49 | $117.49 | $134.90 | |
Medica
| Professional | $302.00 | $302.00 | $302.00 | |
Molina
| Professional | $58.88 | $58.88 | $58.88 | |
Quartz
| Facility | $173.78 | $173.78 | $213.80 | |
Quartz
| Professional | $173.78 | $309.03 | $309.03 |