| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $708.62 | $708.62 | $849.01 | |
Kaiser Permanente
| Professional | $190.00 | $2,665.56 | $2,933.30 | |
Pacific Source
| Facility | $79,999.20 | $79,999.20 | $79,999.20 | |
Providence
| Facility | $4,562.50 | $4,562.50 | $2,400,000.00 | |
Providence
| Professional | $4,380.00 | $4,562.50 | $2,400,000.00 |