| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $19.00 | $19.00 | $23.75 | |
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 | $90.00 | $90.00 | |
Providence
| Facility | $8.25 | $8.25 | $38.75 | |
Providence
| Professional | $25.93 | $25.93 | $25.93 |