| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $116.02 | $116.02 | $131.84 | |
Medica
| Professional | $299.36 | $299.36 | $299.36 | |
Molina
| Professional | $58.40 | $58.40 | $58.40 | |
Quartz
| Facility | $212.16 | $212.16 | $212.16 | |
Quartz
| Professional | $175.09 | $299.36 | $299.36 |