| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $79.50 | $79.50 | $95.25 | |
Kaiser Permanente
| Professional | $74.00 | $74.00 | $98.00 | |
Medcost
| Professional | $103.00 | $127.50 | $127.50 | |
Sentara
| Facility | $71.30 | $110.98 | $7,420.00 | |
Sentara
| Professional | $71.30 | $110.98 | $7,420.00 |