| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $47.18 | $47.18 | $47.18 | |
Medica
| Facility | $234.25 | $234.25 | $234.25 | |
Medica
| Professional | $67.50 | $67.50 | $67.50 | |
Molina
| Professional | $58.40 | $58.40 | $58.40 | |
Quartz
| Facility | $234.25 | $234.25 | $234.25 | |
Quartz
| Professional | $67.50 | $67.50 | $67.50 |