How much rates vary
Facilitymedian $1 · 10th to 90th $1 to $5Professionalmedian $2 · 10th to 90th $1 to $22
Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.
Rates by insurance carrier
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Facility Modifier None Typical Low $1.20 Median $1.20 Typical High $2.29 | Facility | None | $1.20 | $1.20 | $2.29 |
Aetna Setting Professional Modifier None Typical Low $1.20 Median $1.29 Typical High $1.55 | Professional | None | $1.20 | $1.29 | $1.55 |
Ambetter Setting Professional Modifier None Typical Low $3.16 Median $3.16 Typical High $3.16 | Professional | None | $3.16 | $3.16 | $3.16 |
Anthem BCBS Setting Facility Modifier None Typical Low $0.78 Median $1.00 Typical High $4.07 | Facility | None | $0.78 | $1.00 | $4.07 |
Anthem BCBS Setting Professional Modifier None Typical Low $0.89 Median $1.86 Typical High $5.25 | Professional | None | $0.89 | $1.86 | $5.25 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $1.05 Median $1.05 Typical High $2.75 | Professional | RR · Rental | $1.05 | $1.05 | $2.75 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $0.79 Median $0.79 Typical High $0.79 | Professional | UE · Used equipment | $0.79 | $0.79 | $0.79 |
Blue Shield Setting Facility Modifier None Typical Low $3.89 Median $5.25 Typical High $7.94 | Facility | None | $3.89 | $5.25 | $7.94 |
Blue Shield Setting Professional Modifier None Typical Low $4.17 Median $6.31 Typical High $9.33 | Professional | None | $4.17 | $6.31 | $9.33 |
Central California Alliance for Health Setting Professional Modifier None Typical Low $3.02 Median $6.03 Typical High $7.24 | Professional | None | $3.02 | $6.03 | $7.24 |
Cigna Setting Professional Modifier None Typical Low $2.24 Median $2.24 Typical High $2.24 | Professional | None | $2.24 | $2.24 | $2.24 |
Contra Costa Health Setting Professional Modifier None Typical Low $3.80 Median $4.17 Typical High $6.03 | Professional | None | $3.80 | $4.17 | $6.03 |
Kaiser Permanente Setting Professional Modifier None Typical Low $2.29 Median $4.37 Typical High $120.23 | Professional | None | $2.29 | $4.37 | $120.23 |
Lucent Health Setting Professional Modifier None Typical Low $22.39 Median $22.39 Typical High $28.18 | Professional | None | $22.39 | $22.39 | $28.18 |
Molina Setting Professional Modifier None Typical Low $6.46 Median $6.46 Typical High $6.61 | Professional | None | $6.46 | $6.46 | $6.61 |
Optum Setting Professional Modifier None Typical Low $54.95 Median $54.95 Typical High $70.79 | Professional | None | $54.95 | $54.95 | $70.79 |
Providence Setting Facility Modifier None Typical Low $1.35 Median $3.55 Typical High $3.80 | Facility | None | $1.35 | $3.55 | $3.80 |
Providence Setting Professional Modifier None Typical Low $2.24 Median $2.24 Typical High $2.24 | Professional | None | $2.24 | $2.24 | $2.24 |
Sutter Health Plus Setting Professional Modifier None Typical Low $7.08 Median $7.08 Typical High $7.08 | Professional | None | $7.08 | $7.08 | $7.08 |
United Setting Professional Modifier None Typical Low $1.74 Median $1.86 Typical High $4.79 | Professional | None | $1.74 | $1.86 | $4.79 |
10 more rates with less common billing modifiers
A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $0.59 Median $0.65 Typical High $1.23 | Professional | 52 · Reduced service | $0.59 | $0.65 | $1.23 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.24 Median $0.26 Typical High $0.49 | Professional | 53 · Discontinued | $0.24 | $0.26 | $0.49 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.18 Median $0.19 Typical High $0.37 | Professional | 55 · Aftercare only | $0.18 | $0.19 | $0.37 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.12 Median $0.13 Typical High $0.24 | Professional | 56 · Pre-op care only | $0.12 | $0.13 | $0.24 |
Aetna Setting Professional Modifier AU · Urologic/ostomy supply Typical Low $1.17 Median $1.29 Typical High $1.55 | Professional | AU · Urologic/ostomy supply | $1.17 | $1.29 | $1.55 |
Anthem BCBS Setting Professional Modifier AU · Urologic/ostomy supply Typical Low $3.63 Median $4.47 Typical High $5.50 | Professional | AU · Urologic/ostomy supply | $3.63 | $4.47 | $5.50 |
Kaiser Permanente Setting Professional Modifier AU · Urologic/ostomy supply Typical Low $3.39 Median $4.37 Typical High $10.23 | Professional | AU · Urologic/ostomy supply | $3.39 | $4.37 | $10.23 |
Providence Setting Professional Modifier AU · Urologic/ostomy supply Typical Low $2.14 Median $2.14 Typical High $3.89 | Professional | AU · Urologic/ostomy supply | $2.14 | $2.14 | $3.89 |
Sutter Health Plus Setting Professional Modifier AU · Urologic/ostomy supply Typical Low $7.08 Median $7.08 Typical High $7.08 | Professional | AU · Urologic/ostomy supply | $7.08 | $7.08 | $7.08 |
United Setting Professional Modifier AU · Urologic/ostomy supply Typical Low $3.31 Median $3.31 Typical High $3.31 | Professional | AU · Urologic/ostomy supply | $3.31 | $3.31 | $3.31 |
Where California sits
The same service costs 4.4 times more in Minnesota than in New Hampshire. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.
California· 25th of 51
$2.24
MN $5.25NH $1.20
Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.