| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $82.69 | $82.69 | $119.26 | |
Kaiser Permanente
| Professional | $393.93 | $393.93 | $6,786.00 | |
Lucent Health
| Facility | $133.79 | $169.00 | $212.60 | |
Lucent Health
| Professional | $415.70 | $465.00 | $465.00 | |
United
| Facility | $113.40 | $113.40 | $113.40 |