| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $11.15 | $11.15 | $13.94 | |
Contra Costa Health
| Professional | $99.00 | $99.00 | $99.00 | |
Kaiser Permanente
| Professional | $393.93 | $393.93 | $1,619.00 | |
Lucent Health
| Facility | $70.00 | $90.00 | $90.00 | |
Providence
| Facility | $4.88 | $6.18 | $23.79 | |
Providence
| Professional | $15.04 | $15.04 | $15.04 |