| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $109.65 | $120.23 | $501.19 | |
Kaiser Permanente
| Facility | $199.53 | $199.53 | $338.84 | |
Pacific Source
| Facility | $125.89 | $165.96 | $218.78 | |
Providence
| Facility | $120.23 | $120.23 | $501.19 |