| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $125.89 | $125.89 | $151.36 | |
Kaiser Permanente
| Professional | $323.59 | $323.59 | $323.59 | |
Medcost
| Professional | $100.00 | $125.89 | $125.89 | |
Medcost
| Facility | $87.10 | $123.03 | $186.21 |