How much rates vary
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 $2.51 Median $2.57 Typical High $4.37 | Facility | None | $2.51 | $2.57 | $4.37 |
Aetna Setting Professional Modifier None Typical Low $2.51 Median $2.57 Typical High $2.57 | Professional | None | $2.51 | $2.57 | $2.57 |
Anthem BCBS Setting Facility Modifier None Typical Low $2.75 Median $4.27 Typical High $8.51 | Facility | None | $2.75 | $4.27 | $8.51 |
Anthem BCBS Setting Professional Modifier None Typical Low $2.04 Median $2.40 Typical High $6.03 | Professional | None | $2.04 | $2.40 | $6.03 |
Blue Shield Setting Facility Modifier None Typical Low $2.34 Median $2.63 Typical High $5.25 | Facility | None | $2.34 | $2.63 | $5.25 |
Blue Shield Setting Professional Modifier None Typical Low $2.51 Median $3.09 Typical High $6.31 | Professional | None | $2.51 | $3.09 | $6.31 |
Central California Alliance for Health Setting Professional Modifier None Typical Low $2.29 Median $2.82 Typical High $3.80 | Professional | None | $2.29 | $2.82 | $3.80 |
Cigna Setting Facility Modifier None Typical Low $2.63 Median $4.68 Typical High $6.31 | Facility | None | $2.63 | $4.68 | $6.31 |
Cigna Setting Professional Modifier None Typical Low $2.51 Median $2.51 Typical High $2.51 | Professional | None | $2.51 | $2.51 | $2.51 |
Contra Costa Health Setting Professional Modifier None Typical Low $2.63 Median $2.63 Typical High $2.63 | Professional | None | $2.63 | $2.63 | $2.63 |
Kaiser Permanente Setting Professional Modifier None Typical Low $2.29 Median $2.88 Typical High $7.08 | Professional | None | $2.29 | $2.88 | $7.08 |
Providence Setting Facility Modifier None Typical Low $2.51 Median $4.57 Typical High $7.08 | Facility | None | $2.51 | $4.57 | $7.08 |
Providence Setting Professional Modifier None Typical Low $2.51 Median $2.51 Typical High $2.63 | Professional | None | $2.51 | $2.51 | $2.63 |
United Setting Facility Modifier None Typical Low $2.51 Median $2.51 Typical High $2.51 | Facility | None | $2.51 | $2.51 | $2.51 |
United Setting Professional Modifier None Typical Low $2.40 Median $2.40 Typical High $6.61 | Professional | None | $2.40 | $2.40 | $6.61 |
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 52 · Reduced service Typical Low $1.29 Median $1.29 Typical High $1.29 | Professional | 52 · Reduced service | $1.29 | $1.29 | $1.29 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.51 Median $0.51 Typical High $0.51 | Professional | 53 · Discontinued | $0.51 | $0.51 | $0.51 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.38 Median $0.39 Typical High $0.39 | Professional | 55 · Aftercare only | $0.38 | $0.39 | $0.39 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.26 Median $0.26 Typical High $0.26 | Professional | 56 · Pre-op care only | $0.26 | $0.26 | $0.26 |
Where California sits
The same service costs 1.6 times more in Alaska than in Rhode Island. 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· 14th of 51
$2.63
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.