| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Facility | $42.66 | $67.61 | $104.71 | |
Kaiser Permanente
| Professional | $42.66 | $67.61 | $112.20 | |
Molina
| Professional | $70.79 | $70.79 | $70.79 | |
Pacific Source
| Facility | $67.61 | $91.20 | $93.33 | |
United
| Professional | $40.74 | $64.57 | $107.15 |