| 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 | $90.00 | $101.29 | $113.00 | |
Providence
| Facility | $12.41 | $15.19 | $48.45 | |
Providence
| Professional | $38.90 | $38.90 | $38.90 |