| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $79.70 | $79.70 | $100.23 | |
Kaiser Permanente
| Professional | $393.93 | $393.93 | $11,260.00 | |
Lucent Health
| Facility | $115.34 | $348.00 | $348.00 | |
Lucent Health
| Professional | $874.00 | $874.00 | $874.00 | |
Providence
| Facility | $82.03 | $118.62 | $208.00 | |
Providence
| Professional | $99.01 | $99.01 | $99.01 |