| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $302.00 | $302.00 | $380.19 | |
Kaiser Permanente
| Professional | $398.11 | $398.11 | $398.11 | |
Lucent Health
| Facility | $1,548.82 | $1,548.82 | $1,548.82 | |
Lucent Health
| Professional | $1,621.81 | $1,621.81 | $1,621.81 |