| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Facility | $2,041.74 | $2,041.74 | $9,332.54 | |
Kaiser Permanente
| Professional | $1,819.70 | $2,041.74 | $3,467.37 | |
Pacific Source
| Facility | $3,235.94 | $4,365.16 | $4,365.16 |