How much rates vary
Facilitymedian $5 · 10th to 90th $3 to $10Professionalmedian $5 · 10th to 90th $3 to $562
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 $2.40 Median $2.63 Typical High $2.75 | Facility | None | $2.40 | $2.63 | $2.75 |
Aetna Setting Professional Modifier None Typical Low $2.40 Median $2.63 Typical High $2.82 | Professional | None | $2.40 | $2.63 | $2.82 |
Ambetter Setting Professional Modifier None Typical Low $4.47 Median $4.47 Typical High $5.50 | Professional | None | $4.47 | $4.47 | $5.50 |
Anthem BCBS Setting Facility Modifier None Typical Low $2.51 Median $3.24 Typical High $13.18 | Facility | None | $2.51 | $3.24 | $13.18 |
Anthem BCBS Setting Professional Modifier None Typical Low $3.47 Median $6.03 Typical High $13.18 | Professional | None | $3.47 | $6.03 | $13.18 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $3.47 Median $3.47 Typical High $3.47 | Professional | RR · Rental | $3.47 | $3.47 | $3.47 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $2.57 Median $2.57 Typical High $2.57 | Professional | UE · Used equipment | $2.57 | $2.57 | $2.57 |
Blue Shield Setting Facility Modifier None Typical Low $9.33 Median $12.59 Typical High $19.05 | Facility | None | $9.33 | $12.59 | $19.05 |
Blue Shield Setting Professional Modifier None Typical Low $10.00 Median $19.05 Typical High $33.88 | Professional | None | $10.00 | $19.05 | $33.88 |
Central California Alliance for Health Setting Professional Modifier None Typical Low $2.63 Median $4.27 Typical High $7.24 | Professional | None | $2.63 | $4.27 | $7.24 |
Cigna Setting Facility Modifier None Typical Low $5.37 Median $5.37 Typical High $5.37 | Facility | None | $5.37 | $5.37 | $5.37 |
Cigna Setting Professional Modifier None Typical Low $4.57 Median $4.57 Typical High $5.37 | Professional | None | $4.57 | $4.57 | $5.37 |
Contra Costa Health Setting Professional Modifier None Typical Low $7.24 Median $10.00 Typical High $10.96 | Professional | None | $7.24 | $10.00 | $10.96 |
Kaiser Permanente Setting Professional Modifier None Typical Low $5.50 Median $6.46 Typical High $20.89 | Professional | None | $5.50 | $6.46 | $20.89 |
Lucent Health Setting Professional Modifier None Typical Low $63.10 Median $63.10 Typical High $562.34 | Professional | None | $63.10 | $63.10 | $562.34 |
Molina Setting Professional Modifier None Typical Low $7.59 Median $7.59 Typical High $7.59 | Professional | None | $7.59 | $7.59 | $7.59 |
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 $2.57 Median $5.37 Typical High $9.12 | Facility | None | $2.57 | $5.37 | $9.12 |
Providence Setting Professional Modifier None Typical Low $4.57 Median $4.57 Typical High $5.37 | Professional | None | $4.57 | $4.57 | $5.37 |
Sutter Health Plus Setting Professional Modifier None Typical Low $16.98 Median $16.98 Typical High $16.98 | Professional | None | $16.98 | $16.98 | $16.98 |
United Setting Professional Modifier None Typical Low $3.55 Median $4.27 Typical High $11.48 | Professional | None | $3.55 | $4.27 | $11.48 |
2 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 55 · Aftercare only Typical Low $0.36 Median $0.39 Typical High $0.59 | Professional | 55 · Aftercare only | $0.36 | $0.39 | $0.59 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.24 Median $0.26 Typical High $0.39 | Professional | 56 · Pre-op care only | $0.24 | $0.26 | $0.39 |
Where California sits
The same service costs 4.2 times more in Hawaii than in Kentucky. 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· 33rd of 51
$4.79
HI $15.85KY $3.80
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.