How much rates vary
Facilitymedian $302 · 10th to 90th $95 to $575Professionalmedian $209 · 10th to 90th $200 to $407
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 $204.17 Median $257.04 Typical High $537.03 | Facility | None | $204.17 | $257.04 | $537.03 |
Aetna Setting Professional Modifier None Typical Low $204.17 Median $208.93 Typical High $288.40 | Professional | None | $204.17 | $208.93 | $288.40 |
Anthem BCBS Setting Facility Modifier None Typical Low $223.87 Median $338.84 Typical High $707.95 | Facility | None | $223.87 | $338.84 | $707.95 |
Anthem BCBS Setting Professional Modifier None Typical Low $208.93 Median $208.93 Typical High $288.40 | Professional | None | $208.93 | $208.93 | $288.40 |
Blue Shield Setting Facility Modifier None Typical Low $75.86 Median $199.53 Typical High $338.84 | Facility | None | $75.86 | $199.53 | $338.84 |
Blue Shield Setting Professional Modifier None Typical Low $208.93 Median $208.93 Typical High $257.04 | Professional | None | $208.93 | $208.93 | $257.04 |
Central California Alliance for Health Setting Professional Modifier None Typical Low $204.17 Median $223.87 Typical High $223.87 | Professional | None | $204.17 | $223.87 | $223.87 |
Cigna Setting Facility Modifier None Typical Low $204.17 Median $371.54 Typical High $512.86 | Facility | None | $204.17 | $371.54 | $512.86 |
Cigna Setting Professional Modifier None Typical Low $204.17 Median $204.17 Typical High $204.17 | Professional | None | $204.17 | $204.17 | $204.17 |
Contra Costa Health Setting Professional Modifier None Typical Low $199.53 Median $199.53 Typical High $239.88 | Professional | None | $199.53 | $199.53 | $239.88 |
Kaiser Permanente Setting Professional Modifier None Typical Low $186.21 Median $204.17 Typical High $380.19 | Professional | None | $186.21 | $204.17 | $380.19 |
Lucent Health Setting Professional Modifier None Typical Low $891.25 Median $891.25 Typical High $891.25 | Professional | None | $891.25 | $891.25 | $891.25 |
Providence Setting Facility Modifier None Typical Low $204.17 Median $354.81 Typical High $549.54 | Facility | None | $204.17 | $354.81 | $549.54 |
Providence Setting Professional Modifier None Typical Low $204.17 Median $204.17 Typical High $204.17 | Professional | None | $204.17 | $204.17 | $204.17 |
United Setting Professional Modifier None Typical Low $186.21 Median $199.53 Typical High $239.88 | Professional | None | $186.21 | $199.53 | $239.88 |
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 $102.33 Median $128.82 Typical High $263.03 | Facility | 52 · Reduced service | $102.33 | $128.82 | $263.03 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $40.74 Median $51.29 Typical High $107.15 | Facility | 53 · Discontinued | $40.74 | $51.29 | $107.15 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $30.90 Median $38.02 Typical High $79.43 | Facility | 55 · Aftercare only | $30.90 | $38.02 | $79.43 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $20.42 Median $25.70 Typical High $53.70 | Facility | 56 · Pre-op care only | $20.42 | $25.70 | $53.70 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $102.33 Median $104.71 Typical High $104.71 | Professional | 52 · Reduced service | $102.33 | $104.71 | $104.71 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $40.74 Median $41.69 Typical High $41.69 | Professional | 53 · Discontinued | $40.74 | $41.69 | $41.69 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $30.90 Median $30.90 Typical High $30.90 | Professional | 55 · Aftercare only | $30.90 | $30.90 | $30.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $20.42 Median $20.89 Typical High $20.89 | Professional | 56 · Pre-op care only | $20.42 | $20.89 | $20.89 |
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· 18th of 51
$209
AK $251NJ $204
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.