| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $53.80 | $99.50 | $109.35 | |
Medica
| Facility | $24.77 | $47.28 | $85.18 | |
Medica
| Professional | $246.00 | $246.00 | $246.00 |
Ffs - Not Available
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $53.80 | $99.50 | $109.35 | |
Medica
| Facility | $24.77 | $47.28 | $85.18 | |
Medica
| Professional | $246.00 | $246.00 | $246.00 |