| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Professional | $25.70 | $36.31 | $87.10 | |
Lucent Health
| Facility | $100.00 | $100.00 | $100.00 | |
Lucent Health
| Professional | $112.20 | $112.20 | $112.20 | |
United
| Professional | $10.47 | $10.47 | $54.95 |