| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $946.50 | $993.35 | $1,190.15 | |
Kaiser Permanente
| Professional | $170.00 | $170.00 | $178.00 | |
Moda Health
| Professional | $559.54 | $584.96 | $636.51 | |
Pacific Source
| Facility | $822.84 | $79,999.20 | $79,999.20 |