| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $17.48 | $20.96 | $73.34 | |
Kaiser Permanente
| Professional | $150.00 | $170.00 | $178.00 | |
Pacific Source
| Facility | $79,999.20 | $79,999.20 | $79,999.20 | |
Providence
| Professional | $45.00 | $45.00 | $50.00 |