| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $49.89 | $49.89 | $59.77 | |
Kaiser Permanente
| Professional | $38.39 | $47.00 | $66.00 | |
Medcost
| Facility | $22.25 | $22.25 | $99.86 | |
Medcost
| Professional | $12.00 | $33.00 | $60.00 |