| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $8.60 | $9.02 | $10.81 | |
Kaiser Permanente
| Professional | $170.00 | $170.00 | $178.00 | |
Pacific Source
| Facility | $79,999.20 | $79,999.20 | $79,999.20 | |
Providence
| Professional | $18.79 | $19.57 | $44.59 |