| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $778.51 | $988.70 | $1,654.98 | |
Kaiser Permanente
| Professional | $260.00 | $475.00 | $1,006.00 | |
Lucent Health
| Facility | $871.20 | $2,968.44 | $2,968.44 | |
Lucent Health
| Professional | $4,357.89 | $4,357.89 | $4,357.89 | |
Molina
| Professional | $30.00 | $60.00 | $85.00 |