| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $566.13 | $667.46 | $1,121.33 | |
Cigna
| Facility | 52 | $221.01 | $221.01 | $221.01 |
Cigna
| Facility | 53 | $55.25 | $55.25 | $55.25 |
Kaiser Permanente
| Professional | $238.67 | $305.32 | $517.10 | |
United
| Facility | $418.00 | $453.00 | $1,330.00 |