| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $22.38 | $23.41 | $139.19 |
Contra Costa Health
| Professional | 26 | $11.98 | $25.79 | $34.82 |
Kaiser Permanente
| Professional | 26 | $21.17 | $30.78 | $54.00 |
Lucent Health
| Facility | 26 | $68.72 | $134.00 | $134.00 |