| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $193.11 | $211.70 | $266.19 | |
Medica
| Facility | $201.68 | $201.68 | $372.36 | |
Medica
| Professional | $406.95 | $523.28 | $523.28 |
Prolonged service(s) in the outpatient setting requiring direct patient contact beyond the time of the usual service; each additional 30 minutes (List separately in addition to code for prolonged service)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $193.11 | $211.70 | $266.19 | |
Medica
| Facility | $201.68 | $201.68 | $372.36 | |
Medica
| Professional | $406.95 | $523.28 | $523.28 |