| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $72.38 | $76.72 | $91.92 | |
Contra Costa Health
| Professional | $96.08 | $96.08 | $115.30 | |
Kaiser Permanente
| Professional | $129.00 | $638.07 | $801.00 | |
Lucent Health
| Facility | $134.40 | $603.90 | $603.90 | |
Lucent Health
| Professional | $295.68 | $295.68 | $295.68 |