| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $412.49 | $412.49 | $486.81 | |
Aetna
| Facility | TC | $83.99 | $87.40 | $174.79 |
Aetna
| Professional | $63.07 | $95.48 | $500.00 | |
Aetna
| Professional | 26 | $31.82 | $77.31 | $600.49 |
Aetna
| Professional | 52 | $27.00 | $46.62 | $59.27 |
Aetna
| Professional | TC | $31.89 | $74.59 | $600.04 |
Ambetter
| Professional | $36.88 | $44.42 | $127.12 | |
Ambetter
| Professional | 26 | $18.10 | $45.25 | $168.82 |
Ambetter
| Professional | TC | $17.42 | $20.58 | $196.13 |
Anthem BCBS
| Professional | $74.01 | $129.69 | $250.24 | |
Anthem BCBS
| Professional | 26 | $36.67 | $52.80 | $108.63 |
Anthem BCBS
| Professional | TC | $22.50 | $79.19 | $142.29 |
Blue Shield
| Professional | $75.14 | $104.13 | $253.84 | |
Blue Shield
| Professional | 26 | $37.68 | $53.34 | $129.43 |
Blue Shield
| Professional | TC | $37.46 | $50.78 | $121.90 |
Cigna
| Facility | $82.32 | $82.32 | $82.32 | |
Cigna
| Professional | $36.57 | $58.10 | $191.45 | |
Cigna
| Professional | 26 | $18.71 | $22.77 | $81.72 |
Cigna
| Professional | TC | $16.07 | $37.36 | $118.33 |
Contra Costa Health
| Professional | $40.99 | $90.02 | $121.53 | |
Contra Costa Health
| Professional | 26 | $32.79 | $41.23 | $55.66 |
Contra Costa Health
| Professional | TC | $8.19 | $48.80 | $65.88 |
HealthNet
| Professional | $73.73 | $77.36 | $165.23 | |
HealthNet
| Professional | 26 | $36.09 | $52.14 | $79.16 |
Kaiser Permanente
| Professional | $71.12 | $85.07 | $150.93 | |
Kaiser Permanente
| Professional | 26 | $32.97 | $49.48 | $61.85 |
Kaiser Permanente
| Professional | TC | $36.06 | $58.37 | $73.20 |
Lucent Health
| Facility | $169.91 | $369.57 | $375.35 | |
Lucent Health
| Facility | 26 | $100.00 | $163.47 | $179.84 |
Lucent Health
| Facility | TC | $68.31 | $216.27 | $216.27 |
Lucent Health
| Professional | $547.54 | $563.97 | $592.20 | |
Lucent Health
| Professional | 26 | $292.24 | $292.24 | $292.24 |
Lucent Health
| Professional | TC | $349.50 | $352.47 | $359.07 |
Providence
| Facility | $80.59 | $108.05 | $155.66 | |
Providence
| Professional | $39.14 | $109.26 | $197.60 | |
Providence
| Professional | 26 | $19.17 | $23.98 | $106.57 |
Providence
| Professional | 52 | $77.18 | $80.54 | $85.26 |
Providence
| Professional | TC | $15.99 | $39.35 | $118.33 |
Sutter Health Plus
| Professional | $264.83 | $264.83 | $264.83 | |
Sutter Health Plus
| Professional | 26 | $143.93 | $143.93 | $143.93 |
Sutter Health Plus
| Professional | TC | $120.90 | $120.90 | $120.90 |
The Alliance
| Professional | $72.81 | $72.81 | $100.11 | |
United
| Facility | $147.00 | $147.00 | $147.00 | |
United
| Professional | $42.88 | $62.17 | $159.13 | |
United
| Professional | 26 | $21.65 | $23.98 | $86.55 |
United
| Professional | TC | $19.27 | $38.54 | $109.61 |