How much rates vary
Facilitymedian $4 · 10th to 90th $2 to $8Professionalmedian $4 · 10th to 90th $2 to $50
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 $1.78 Median $1.95 Typical High $1.95 | Facility | None | $1.78 | $1.95 | $1.95 |
Aetna Setting Professional Modifier None Typical Low $1.78 Median $1.95 Typical High $3.24 | Professional | None | $1.78 | $1.95 | $3.24 |
Anthem BCBS Setting Facility Modifier None Typical Low $2.34 Median $3.02 Typical High $12.30 | Facility | None | $2.34 | $3.02 | $12.30 |
Anthem BCBS Setting Professional Modifier None Typical Low $3.24 Median $4.68 Typical High $9.33 | Professional | None | $3.24 | $4.68 | $9.33 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $3.24 Median $3.24 Typical High $3.39 | Professional | RR · Rental | $3.24 | $3.24 | $3.39 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $2.40 Median $2.40 Typical High $2.40 | Professional | UE · Used equipment | $2.40 | $2.40 | $2.40 |
Blue Shield Setting Facility Modifier None Typical Low $6.92 Median $9.12 Typical High $13.80 | Facility | None | $6.92 | $9.12 | $13.80 |
Blue Shield Setting Professional Modifier None Typical Low $7.24 Median $13.80 Typical High $24.55 | Professional | None | $7.24 | $13.80 | $24.55 |
Central California Alliance for Health Setting Professional Modifier None Typical Low $5.37 Median $7.59 Typical High $7.76 | Professional | None | $5.37 | $7.59 | $7.76 |
Cigna Setting Facility Modifier None Typical Low $3.89 Median $3.89 Typical High $4.37 | Facility | None | $3.89 | $3.89 | $4.37 |
Cigna Setting Professional Modifier None Typical Low $3.31 Median $3.31 Typical High $3.89 | Professional | None | $3.31 | $3.31 | $3.89 |
Contra Costa Health Setting Professional Modifier None Typical Low $5.37 Median $7.41 Typical High $7.94 | Professional | None | $5.37 | $7.41 | $7.94 |
Kaiser Permanente Setting Professional Modifier None Typical Low $3.98 Median $5.37 Typical High $15.49 | Professional | None | $3.98 | $5.37 | $15.49 |
Lucent Health Setting Professional Modifier None Typical Low $33.11 Median $33.11 Typical High $50.12 | Professional | None | $33.11 | $33.11 | $50.12 |
Molina Setting Professional Modifier None Typical Low $9.55 Median $9.55 Typical High $33.11 | Professional | None | $9.55 | $9.55 | $33.11 |
Providence Setting Facility Modifier None Typical Low $2.95 Median $3.89 Typical High $6.61 | Facility | None | $2.95 | $3.89 | $6.61 |
Providence Setting Professional Modifier None Typical Low $3.31 Median $3.31 Typical High $3.89 | Professional | None | $3.31 | $3.31 | $3.89 |
Sutter Health Plus Setting Professional Modifier None Typical Low $12.30 Median $12.30 Typical High $12.30 | Professional | None | $12.30 | $12.30 | $12.30 |
United Setting Professional Modifier None Typical Low $2.57 Median $3.09 Typical High $8.32 | Professional | None | $2.57 | $3.09 | $8.32 |
5 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 $0.89 Median $0.98 Typical High $1.51 | Professional | 52 · Reduced service | $0.89 | $0.98 | $1.51 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.36 Median $0.39 Typical High $0.60 | Professional | 53 · Discontinued | $0.36 | $0.39 | $0.60 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.27 Median $0.28 Typical High $0.45 | Professional | 55 · Aftercare only | $0.27 | $0.28 | $0.45 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.18 Median $0.20 Typical High $0.30 | Professional | 56 · Pre-op care only | $0.18 | $0.20 | $0.30 |
Ambetter Setting Professional Modifier KX · Policy requirements met Typical Low $4.68 Median $4.68 Typical High $4.68 | Professional | KX · Policy requirements met | $4.68 | $4.68 | $4.68 |
Where California sits
The same service costs 2.1 times more in Montana than in New Jersey. 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· 36th of 51
$3.89
MT $6.92NJ $3.31
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.