How much rates vary
Facilitymedian $5 · 10th to 90th $3 to $10Professionalmedian $5 · 10th to 90th $3 to $65
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 $2.24 Median $2.45 Typical High $2.57 | Facility | None | $2.24 | $2.45 | $2.57 |
Aetna Setting Professional Modifier None Typical Low $2.24 Median $2.45 Typical High $3.80 | Professional | None | $2.24 | $2.45 | $3.80 |
Anthem BCBS Setting Facility Modifier None Typical Low $3.09 Median $3.98 Typical High $16.22 | Facility | None | $3.09 | $3.98 | $16.22 |
Anthem BCBS Setting Professional Modifier None Typical Low $4.37 Median $5.62 Typical High $11.22 | Professional | None | $4.37 | $5.62 | $11.22 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $4.17 Median $4.17 Typical High $4.47 | Professional | RR · Rental | $4.17 | $4.17 | $4.47 |
Blue Shield Setting Facility Modifier None Typical Low $8.91 Median $11.75 Typical High $17.78 | Facility | None | $8.91 | $11.75 | $17.78 |
Blue Shield Setting Professional Modifier None Typical Low $9.33 Median $17.78 Typical High $31.62 | Professional | None | $9.33 | $17.78 | $31.62 |
Central California Alliance for Health Setting Professional Modifier None Typical Low $6.92 Median $9.77 Typical High $10.00 | Professional | None | $6.92 | $9.77 | $10.00 |
Cigna Setting Facility Modifier None Typical Low $5.01 Median $5.01 Typical High $5.37 | Facility | None | $5.01 | $5.01 | $5.37 |
Cigna Setting Professional Modifier None Typical Low $4.27 Median $4.27 Typical High $5.01 | Professional | None | $4.27 | $4.27 | $5.01 |
Contra Costa Health Setting Professional Modifier None Typical Low $6.92 Median $9.33 Typical High $10.23 | Professional | None | $6.92 | $9.33 | $10.23 |
Kaiser Permanente Setting Professional Modifier None Typical Low $5.13 Median $7.08 Typical High $19.50 | Professional | None | $5.13 | $7.08 | $19.50 |
Lucent Health Setting Professional Modifier None Typical Low $42.66 Median $42.66 Typical High $64.57 | Professional | None | $42.66 | $42.66 | $64.57 |
Molina Setting Professional Modifier None Typical Low $12.30 Median $12.30 Typical High $12.30 | Professional | None | $12.30 | $12.30 | $12.30 |
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 $2.34 Median $5.01 Typical High $8.51 | Facility | None | $2.34 | $5.01 | $8.51 |
Providence Setting Professional Modifier None Typical Low $4.27 Median $4.27 Typical High $5.01 | Professional | None | $4.27 | $4.27 | $5.01 |
Sutter Health Plus Setting Professional Modifier None Typical Low $15.85 Median $15.85 Typical High $15.85 | Professional | None | $15.85 | $15.85 | $15.85 |
United Setting Professional Modifier None Typical Low $3.31 Median $3.98 Typical High $10.72 | Professional | None | $3.31 | $3.98 | $10.72 |
4 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 $0.34 Median $0.37 Typical High $0.56 | Professional | 55 · Aftercare only | $0.34 | $0.37 | $0.56 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.23 Median $0.25 Typical High $0.37 | Professional | 56 · Pre-op care only | $0.23 | $0.25 | $0.37 |
Ambetter Setting Professional Modifier KX · Policy requirements met Typical Low $6.03 Median $6.03 Typical High $6.03 | Professional | KX · Policy requirements met | $6.03 | $6.03 | $6.03 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $3.16 Median $3.16 Typical High $4.47 | Professional | UE · Used equipment | $3.16 | $3.16 | $4.47 |
Where California sits
The same service costs 2.1 times more in Hawaii than in Delaware. 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· 35th of 51
$5.01
HI $8.91DE $4.27
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.