| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $218.78 | $218.78 | $269.15 | |
Kaiser Permanente
| Professional | $398.11 | $398.11 | $1,698.24 | |
Lucent Health
| Facility | $776.25 | $776.25 | $776.25 | |
Lucent Health
| Professional | $1,023.29 | $1,023.29 | $1,023.29 | |
Providence
| Facility | $177.83 | $245.47 | $331.13 | |
Providence
| Professional | $199.53 | $199.53 | $199.53 |