| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $21.48 | $21.48 | $26.85 | |
Contra Costa Health
| Professional | $99.00 | $99.00 | $99.00 | |
Kaiser Permanente
| Professional | $393.93 | $393.93 | $1,619.00 | |
Lucent Health
| Facility | $72.00 | $90.00 | $90.00 | |
Providence
| Facility | $9.32 | $11.80 | $51.00 | |
Providence
| Professional | $29.04 | $29.04 | $29.04 |