| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $162.75 | $172.52 | $206.69 | |
Contra Costa Health
| Professional | $165.00 | $165.00 | $198.00 | |
Kaiser Permanente
| Professional | $129.00 | $638.07 | $801.00 | |
Lucent Health
| Facility | $242.65 | $1,097.59 | $1,097.59 | |
Lucent Health
| Professional | $2,848.34 | $2,848.34 | $2,848.34 |