| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $6,165.95 | $6,165.95 | $6,165.95 | |
Kaiser Permanente
| Facility | $102.33 | $120.23 | $151.36 | |
Providence
| Facility | $6,165.95 | $6,165.95 | $6,165.95 |
New Technology - Level 26 ($4001-$4500)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $6,165.95 | $6,165.95 | $6,165.95 | |
Kaiser Permanente
| Facility | $102.33 | $120.23 | $151.36 | |
Providence
| Facility | $6,165.95 | $6,165.95 | $6,165.95 |