| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $79.13 | $79.13 | $98.91 | |
Contra Costa Health
| Professional | $99.00 | $99.00 | $99.00 | |
Kaiser Permanente
| Professional | $203.49 | $203.49 | $393.93 | |
Lucent Health
| Facility | $80.00 | $90.00 | $90.00 |