| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $376.00 | $530.82 | $891.79 | |
Cigna
| Facility | 52 | $16.70 | $16.70 | $16.70 |
Kaiser Permanente
| Professional | $18.47 | $23.33 | $41.55 | |
United
| Facility | $418.00 | $453.00 | $1,330.00 |