| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $281.84 | $281.84 | $346.74 | |
Kaiser Permanente
| Facility | $117.49 | $194.98 | $316.23 | |
Providence
| Facility | $281.84 | $281.84 | $346.74 |
Special Charges-Other Special Charges
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $281.84 | $281.84 | $346.74 | |
Kaiser Permanente
| Facility | $117.49 | $194.98 | $316.23 | |
Providence
| Facility | $281.84 | $281.84 | $346.74 |