| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $111.70 | $111.70 | $111.70 | |
Cigna
| Professional | $16.77 | $16.77 | $16.77 | |
Kaiser Permanente
| Professional | $1,400.00 | $1,400.00 | $1,400.00 | |
Wellpoint
| Professional | $2,500.00 | $2,500.00 | $2,500.00 |