| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Professional | $1,973.65 | $1,973.65 | $1,973.65 | |
Pacific Source
| Facility | $1,239.15 | $1,509.51 | $1,509.51 | |
Providence
| Facility | $1,947.03 | $1,947.03 | $2,400,000.00 | |
Providence
| Professional | $981.65 | $1,815.20 | $2,087.48 |