| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Facility | $150.00 | $165.00 | $190.00 | |
Providence
| Facility | $3,142.42 | $3,142.42 | $3,142.42 |
New Technology - Level 16 ($1401 - $1500)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Facility | $150.00 | $165.00 | $190.00 | |
Providence
| Facility | $3,142.42 | $3,142.42 | $3,142.42 |