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 $0.76 Median $0.89 Typical High $1.26 | Facility | None | $0.76 | $0.89 | $1.26 |
Aetna Setting Professional Modifier None Typical Low $0.76 Median $0.83 Typical High $1.48 | Professional | None | $0.76 | $0.83 | $1.48 |
Ambetter Setting Professional Modifier None Typical Low $2.40 Median $2.40 Typical High $2.40 | Professional | None | $2.40 | $2.40 | $2.40 |
Anthem BCBS Setting Facility Modifier None Typical Low $0.69 Median $0.81 Typical High $1.12 | Facility | None | $0.69 | $0.81 | $1.12 |
Anthem BCBS Setting Professional Modifier None Typical Low $0.69 Median $0.72 Typical High $1.95 | Professional | None | $0.69 | $0.72 | $1.95 |
Blue Shield Setting Facility Modifier None Typical Low $1.00 Median $1.20 Typical High $1.70 | Facility | None | $1.00 | $1.20 | $1.70 |
Blue Shield Setting Professional Modifier None Typical Low $0.76 Median $0.91 Typical High $2.34 | Professional | None | $0.76 | $0.91 | $2.34 |
Central California Alliance for Health Setting Professional Modifier None Typical Low $0.68 Median $0.83 Typical High $1.12 | Professional | None | $0.68 | $0.83 | $1.12 |
Cigna Setting Facility Modifier None Typical Low $0.78 Median $1.38 Typical High $1.86 | Facility | None | $0.78 | $1.38 | $1.86 |
Cigna Setting Professional Modifier None Typical Low $0.76 Median $0.76 Typical High $0.76 | Professional | None | $0.76 | $0.76 | $0.76 |
Contra Costa Health Setting Professional Modifier None Typical Low $0.83 Median $0.83 Typical High $0.83 | Professional | None | $0.83 | $0.83 | $0.83 |
Kaiser Permanente Setting Professional Modifier None Typical Low $0.68 Median $0.81 Typical High $2.00 | Professional | None | $0.68 | $0.81 | $2.00 |
Molina Setting Professional Modifier None Typical Low $0.72 Median $0.72 Typical High $0.72 | Professional | None | $0.72 | $0.72 | $0.72 |
Providence Setting Facility Modifier None Typical Low $0.76 Median $1.35 Typical High $2.09 | Facility | None | $0.76 | $1.35 | $2.09 |
Providence Setting Professional Modifier None Typical Low $0.76 Median $0.76 Typical High $1.20 | Professional | None | $0.76 | $0.76 | $1.20 |
Sutter Health Plus Setting Professional Modifier None Typical Low $1.15 Median $1.15 Typical High $1.15 | Professional | None | $1.15 | $1.15 | $1.15 |
United Setting Facility Modifier None Typical Low $2.82 Median $2.82 Typical High $2.82 | Facility | None | $2.82 | $2.82 | $2.82 |
United Setting Professional Modifier None Typical Low $0.69 Median $0.72 Typical High $3.72 | Professional | None | $0.69 | $0.72 | $3.72 |
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 52 · Reduced service Typical Low $0.38 Median $0.38 Typical High $0.38 | Professional | 52 · Reduced service | $0.38 | $0.38 | $0.38 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.15 Median $0.15 Typical High $0.15 | Professional | 53 · Discontinued | $0.15 | $0.15 | $0.15 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.11 Median $0.11 Typical High $0.11 | Professional | 55 · Aftercare only | $0.11 | $0.11 | $0.11 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.08 Median $0.08 Typical High $0.08 | Professional | 56 · Pre-op care only | $0.08 | $0.08 | $0.08 |
Where California sits
The same service costs 5.2 times more in Vermont 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· 20th of 51
$0.85
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.