| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $141.25 | $575.44 | $630.96 | |
Cigna
| Facility | AS | $14.13 | $14.13 | $14.13 |
Kaiser Permanente
| Professional | $64.57 | $85.11 | $123.03 | |
United
| Facility | $75.86 | $107.15 | $602.56 |