| 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 | $70.00 | $90.00 | $90.00 | |
Providence
| Facility | $8.01 | $10.38 | $22.10 | |
Providence
| Professional | $24.89 | $24.89 | $24.89 |