| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $285.00 | $285.00 | $350.00 | |
Kaiser Permanente
| Facility | $118.50 | $195.00 | $315.00 | |
Providence
| Facility | $285.00 | $285.00 | $350.00 |
Special Charges - Other
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $285.00 | $285.00 | $350.00 | |
Kaiser Permanente
| Facility | $118.50 | $195.00 | $315.00 | |
Providence
| Facility | $285.00 | $285.00 | $350.00 |