| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $135.61 | $174.83 | $209.47 | |
Kaiser Permanente
| Professional | $443.01 | $443.01 | $443.01 | |
Medcost
| Facility | $115.42 | $154.19 | $182.29 | |
Medcost
| Professional | $69.00 | $106.00 | $188.00 |