| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Professional | $109.65 | $128.82 | $144.54 | |
Pacific Source
| Facility | $19.50 | $28.84 | $81.28 | |
Providence
| Facility | $1,659,586.91 | $1,659,586.91 | $1,659,586.91 | |
Providence
| Professional | $44.67 | $52.48 | $61.66 | |
United
| Professional | $70.79 | $112.20 | $147.91 |