| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Facility | $151.36 | $165.96 | $190.55 | |
Providence
| Facility | $758.58 | $758.58 | $758.58 |
New Technology - Level 5 ($301 - $400)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Facility | $151.36 | $165.96 | $190.55 | |
Providence
| Facility | $758.58 | $758.58 | $758.58 |