| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Professional | $393.93 | $393.93 | $1,619.00 | |
Lucent Health
| Facility | $305.18 | $499.89 | $499.89 | |
Lucent Health
| Professional | $632.03 | $632.03 | $632.03 | |
Providence
| Facility | $133.00 | $140.00 | $140.00 | |
Sutter Health Plus
| Professional | $352.34 | $352.34 | $352.34 |