How much rates vary
Facilitymedian $3 · 10th to 90th $2 to $5Professionalmedian $2 · 10th to 90th $2 to $3
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 $2.00 Median $2.75 Typical High $4.68 | Facility | None | $2.00 | $2.75 | $4.68 |
Aetna Setting Professional Modifier None Typical Low $2.00 Median $2.00 Typical High $2.95 | Professional | None | $2.00 | $2.00 | $2.95 |
Anthem BCBS Setting Facility Modifier None Typical Low $1.82 Median $2.14 Typical High $2.95 | Facility | None | $1.82 | $2.14 | $2.95 |
Anthem BCBS Setting Professional Modifier None Typical Low $1.82 Median $1.82 Typical High $2.57 | Professional | None | $1.82 | $1.82 | $2.57 |
Blue Shield Setting Facility Modifier None Typical Low $1.95 Median $2.29 Typical High $3.47 | Facility | None | $1.95 | $2.29 | $3.47 |
Blue Shield Setting Professional Modifier None Typical Low $2.14 Median $2.14 Typical High $2.63 | Professional | None | $2.14 | $2.14 | $2.63 |
Central California Alliance for Health Setting Professional Modifier None Typical Low $2.00 Median $2.19 Typical High $2.19 | Professional | None | $2.00 | $2.19 | $2.19 |
Cigna Setting Facility Modifier None Typical Low $2.00 Median $3.63 Typical High $5.01 | Facility | None | $2.00 | $3.63 | $5.01 |
Cigna Setting Professional Modifier None Typical Low $2.00 Median $2.00 Typical High $2.00 | Professional | None | $2.00 | $2.00 | $2.00 |
Contra Costa Health Setting Professional Modifier None Typical Low $1.95 Median $2.09 Typical High $2.34 | Professional | None | $1.95 | $2.09 | $2.34 |
Kaiser Permanente Setting Professional Modifier None Typical Low $1.70 Median $1.78 Typical High $3.09 | Professional | None | $1.70 | $1.78 | $3.09 |
Lucent Health Setting Professional Modifier None Typical Low $1.82 Median $2.00 Typical High $3.63 | Professional | None | $1.82 | $2.00 | $3.63 |
Molina Setting Professional Modifier None Typical Low $1.62 Median $1.62 Typical High $1.62 | Professional | None | $1.62 | $1.62 | $1.62 |
Providence Setting Facility Modifier None Typical Low $2.00 Median $3.55 Typical High $5.50 | Facility | None | $2.00 | $3.55 | $5.50 |
Providence Setting Professional Modifier None Typical Low $2.00 Median $2.00 Typical High $2.00 | Professional | None | $2.00 | $2.00 | $2.00 |
Sutter Health Plus Setting Professional Modifier None Typical Low $2.69 Median $2.69 Typical High $2.69 | Professional | None | $2.69 | $2.69 | $2.69 |
United Setting Facility Modifier None Typical Low $4.07 Median $4.07 Typical High $4.07 | Facility | None | $4.07 | $4.07 | $4.07 |
United Setting Professional Modifier None Typical Low $1.45 Median $1.78 Typical High $2.14 | Professional | None | $1.45 | $1.78 | $2.14 |
8 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 Facility Modifier 52 · Reduced service Typical Low $1.00 Median $1.38 Typical High $2.29 | Facility | 52 · Reduced service | $1.00 | $1.38 | $2.29 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $0.40 Median $0.55 Typical High $0.93 | Facility | 53 · Discontinued | $0.40 | $0.55 | $0.93 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $0.30 Median $0.41 Typical High $0.71 | Facility | 55 · Aftercare only | $0.30 | $0.41 | $0.71 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $0.20 Median $0.28 Typical High $0.46 | Facility | 56 · Pre-op care only | $0.20 | $0.28 | $0.46 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $1.00 Median $1.00 Typical High $1.00 | Professional | 52 · Reduced service | $1.00 | $1.00 | $1.00 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.40 Median $0.40 Typical High $0.40 | Professional | 53 · Discontinued | $0.40 | $0.40 | $0.40 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.30 Median $0.30 Typical High $0.30 | Professional | 55 · Aftercare only | $0.30 | $0.30 | $0.30 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.20 Median $0.20 Typical High $0.20 | Professional | 56 · Pre-op care only | $0.20 | $0.20 | $0.20 |
Where California sits
Rates are fairly even across states for this service. 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· 41st of 51
$2.00
AK $2.51OK $1.78
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.