| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $11.36 | $79,999.20 | $79,999.20 | |
Providence
| Facility | $8.88 | $8.88 | $14.20 | |
Providence
| Professional | $8.88 | $8.88 | $8.88 | |
United
| Professional | $7.04 | $7.04 | $7.04 |