| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $76.72 | $76.72 | $91.92 | |
Kaiser Permanente
| Professional | $150.00 | $175.00 | $194.25 | |
Pacific Source
| Facility | $79,999.20 | $79,999.20 | $79,999.20 |
Puraply Or Puraply Am
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $76.72 | $76.72 | $91.92 | |
Kaiser Permanente
| Professional | $150.00 | $175.00 | $194.25 | |
Pacific Source
| Facility | $79,999.20 | $79,999.20 | $79,999.20 |