| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $95.50 | $95.50 | $114.82 | |
Kaiser Permanente
| Professional | $245.47 | $245.47 | $245.47 | |
Medcost
| Professional | $64.57 | $79.43 | $79.43 | |
Medcost
| Facility | $58.88 | $89.13 | $134.90 |