| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $28.50 | $28.50 | $35.63 | |
Contra Costa Health
| Professional | $99.00 | $99.00 | $99.00 | |
Kaiser Permanente
| Professional | $393.93 | $393.93 | $1,619.00 | |
Lucent Health
| Facility | $83.79 | $105.25 | $105.25 | |
Providence
| Facility | $12.41 | $15.73 | $52.25 | |
Providence
| Professional | $38.90 | $38.90 | $38.90 |