| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $645.65 | $645.65 | $812.83 | |
Kaiser Permanente
| Professional | $398.11 | $398.11 | $1,698.24 | |
Lucent Health
| Facility | $1,698.24 | $1,698.24 | $1,698.24 | |
Lucent Health
| Professional | $5,248.07 | $5,248.07 | $5,248.07 | |
Providence
| Facility | $645.65 | $831.76 | $1,230.27 | |
Providence
| Professional | $794.33 | $794.33 | $794.33 |