| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Professional | $105.00 | $393.93 | $801.00 | |
Lucent Health
| Facility | $70.00 | $90.00 | $90.00 | |
Lucent Health
| Professional | $99.98 | $249.57 | $249.57 | |
Providence
| Facility | $18.16 | $27.33 | $35.28 |