| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $50.75 | $63.44 | $88.71 | |
Medica
| Facility | $35.58 | $65.69 | $107.58 | |
Medica
| Professional | $246.00 | $246.00 | $246.00 |
Ffs - Not Available
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $50.75 | $63.44 | $88.71 | |
Medica
| Facility | $35.58 | $65.69 | $107.58 | |
Medica
| Professional | $246.00 | $246.00 | $246.00 |