| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $18.17 | $18.17 | $22.72 | |
Contra Costa Health
| Professional | $99.00 | $99.00 | $99.00 | |
Kaiser Permanente
| Professional | $393.93 | $393.93 | $1,619.00 | |
Lucent Health
| Facility | $166.30 | $211.44 | $211.44 | |
Providence
| Facility | $7.87 | $10.19 | $42.63 | |
Providence
| Professional | $24.38 | $24.38 | $24.38 |