| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $96.29 | $96.29 | $115.37 | |
Kaiser Permanente
| Professional | $245.24 | $245.24 | $245.24 | |
Medcost
| Facility | $59.10 | $86.40 | $108.22 | |
Medcost
| Professional | $24.00 | $65.00 | $105.00 |