| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $47.88 | $47.88 | $57.36 | |
Kaiser Permanente
| Professional | $123.59 | $123.59 | $123.59 | |
Medcost
| Facility | $34.93 | $48.22 | $64.38 | |
Medcost
| Professional | $16.00 | $36.00 | $54.00 |