| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Professional | $891.25 | $1,071.52 | $7,585.78 | |
Pacific Source
| Facility | $4,466.84 | $5,370.32 | $7,079.46 | |
Providence
| Facility | $7,585.78 | $7,585.78 | $7,585.78 | |
Providence
| Professional | $831.76 | $5,495.41 | $8,128.31 | |
United
| Professional | $691.83 | $2,818.38 | $8,709.64 |