| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Professional | $251.19 | $281.84 | $446.68 | |
Kaiser Permanente
| Professional | 26 | $87.10 | $100.00 | $120.23 |
Kaiser Permanente
| Professional | TC | $162.18 | $181.97 | $323.59 |
United
| Professional | $75.86 | $173.78 | $426.58 | |
United
| Professional | 26 | $16.22 | $48.98 | $151.36 |
United
| Professional | TC | $61.66 | $120.23 | $275.42 |