How much rates vary
Facilitymedian $60 · 10th to 90th $39 to $115Professionalmedian $37 · 10th to 90th $36 to $93
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 $36.31 Median $45.71 Typical High $95.50 | Facility | None | $36.31 | $45.71 | $95.50 |
Aetna Setting Professional Modifier None Typical Low $36.31 Median $37.15 Typical High $37.15 | Professional | None | $36.31 | $37.15 | $37.15 |
Anthem BCBS Setting Facility Modifier None Typical Low $39.81 Median $60.26 Typical High $128.82 | Facility | None | $39.81 | $60.26 | $128.82 |
Anthem BCBS Setting Professional Modifier None Typical Low $38.02 Median $38.02 Typical High $56.23 | Professional | None | $38.02 | $38.02 | $56.23 |
Blue Shield Setting Facility Modifier None Typical Low $47.86 Median $47.86 Typical High $91.20 | Facility | None | $47.86 | $47.86 | $91.20 |
Blue Shield Setting Professional Modifier None Typical Low $36.31 Median $36.31 Typical High $45.71 | Professional | None | $36.31 | $36.31 | $45.71 |
Central California Alliance for Health Setting Professional Modifier None Typical Low $36.31 Median $39.81 Typical High $39.81 | Professional | None | $36.31 | $39.81 | $39.81 |
Cigna Setting Facility Modifier None Typical Low $36.31 Median $66.07 Typical High $91.20 | Facility | None | $36.31 | $66.07 | $91.20 |
Cigna Setting Professional Modifier None Typical Low $36.31 Median $36.31 Typical High $36.31 | Professional | None | $36.31 | $36.31 | $36.31 |
Contra Costa Health Setting Professional Modifier None Typical Low $36.31 Median $40.74 Typical High $48.98 | Professional | None | $36.31 | $40.74 | $48.98 |
Kaiser Permanente Setting Professional Modifier None Typical Low $33.11 Median $36.31 Typical High $72.44 | Professional | None | $33.11 | $36.31 | $72.44 |
Lucent Health Setting Professional Modifier None Typical Low $177.83 Median $177.83 Typical High $177.83 | Professional | None | $177.83 | $177.83 | $177.83 |
Providence Setting Facility Modifier None Typical Low $36.31 Median $66.07 Typical High $102.33 | Facility | None | $36.31 | $66.07 | $102.33 |
Providence Setting Professional Modifier None Typical Low $36.31 Median $36.31 Typical High $36.31 | Professional | None | $36.31 | $36.31 | $36.31 |
Sutter Health Plus Setting Professional Modifier None Typical Low $72.44 Median $72.44 Typical High $72.44 | Professional | None | $72.44 | $72.44 | $72.44 |
United Setting Facility Modifier None Typical Low $36.31 Median $36.31 Typical High $144.54 | Facility | None | $36.31 | $36.31 | $144.54 |
United Setting Professional Modifier None Typical Low $36.31 Median $37.15 Typical High $43.65 | Professional | None | $36.31 | $37.15 | $43.65 |
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 $18.20 Median $22.91 Typical High $47.86 | Facility | 52 · Reduced service | $18.20 | $22.91 | $47.86 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $7.24 Median $9.12 Typical High $19.05 | Facility | 53 · Discontinued | $7.24 | $9.12 | $19.05 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $5.50 Median $6.92 Typical High $14.45 | Facility | 55 · Aftercare only | $5.50 | $6.92 | $14.45 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $3.63 Median $4.57 Typical High $9.55 | Facility | 56 · Pre-op care only | $3.63 | $4.57 | $9.55 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $18.20 Median $18.20 Typical High $18.20 | Professional | 52 · Reduced service | $18.20 | $18.20 | $18.20 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $7.24 Median $7.41 Typical High $7.41 | Professional | 53 · Discontinued | $7.24 | $7.41 | $7.41 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $5.50 Median $5.50 Typical High $5.50 | Professional | 55 · Aftercare only | $5.50 | $5.50 | $5.50 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.63 Median $3.72 Typical High $3.72 | Professional | 56 · Pre-op care only | $3.63 | $3.72 | $3.72 |
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· 16th of 51
$37.15
AK $50.12GA $36.31
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.