| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $316.29 | $369.61 | $567.00 | |
Cigna
| Professional | $178.13 | $222.67 | $378.68 | |
Medica
| Professional | $471.07 | $471.07 | $471.07 | |
Quartz
| Facility | $385.08 | $385.08 | $385.08 | |
Quartz
| Professional | $272.77 | $471.07 | $471.07 |