| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $47.08 | $47.08 | $58.85 | |
Contra Costa Health
| Professional | $99.00 | $99.00 | $99.00 | |
Kaiser Permanente
| Professional | $393.93 | $393.93 | $1,619.00 | |
Lucent Health
| Facility | $98.62 | $143.88 | $143.88 | |
Providence
| Facility | $20.63 | $26.73 | $70.13 | |
Providence
| Professional | $64.31 | $64.31 | $64.31 |