How much rates vary
Facilitymedian $59 · 10th to 90th $37 to $105Professionalmedian $38 · 10th to 90th $37 to $74
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 $38.02 Median $47.86 Typical High $97.72 | Facility | None | $38.02 | $47.86 | $97.72 |
Aetna Setting Professional Modifier None Typical Low $38.02 Median $40.74 Typical High $52.48 | Professional | None | $38.02 | $40.74 | $52.48 |
Ambetter Setting Professional Modifier None Typical Low $74.13 Median $74.13 Typical High $74.13 | Professional | None | $74.13 | $74.13 | $74.13 |
Anthem BCBS Setting Facility Modifier None Typical Low $40.74 Median $63.10 Typical High $128.82 | Facility | None | $40.74 | $63.10 | $128.82 |
Anthem BCBS Setting Professional Modifier None Typical Low $38.02 Median $38.02 Typical High $51.29 | Professional | None | $38.02 | $38.02 | $51.29 |
Blue Shield Setting Facility Modifier None Typical Low $36.31 Median $43.65 Typical High $83.18 | Facility | None | $36.31 | $43.65 | $83.18 |
Blue Shield Setting Professional Modifier None Typical Low $38.02 Median $38.02 Typical High $47.86 | Professional | None | $38.02 | $38.02 | $47.86 |
Central California Alliance for Health Setting Professional Modifier None Typical Low $38.02 Median $41.69 Typical High $41.69 | Professional | None | $38.02 | $41.69 | $41.69 |
Cigna Setting Facility Modifier None Typical Low $38.02 Median $67.61 Typical High $93.33 | Facility | None | $38.02 | $67.61 | $93.33 |
Cigna Setting Professional Modifier None Typical Low $38.02 Median $38.02 Typical High $38.02 | Professional | None | $38.02 | $38.02 | $38.02 |
Contra Costa Health Setting Professional Modifier None Typical Low $36.31 Median $37.15 Typical High $44.67 | Professional | None | $36.31 | $37.15 | $44.67 |
Kaiser Permanente Setting Professional Modifier None Typical Low $33.88 Median $37.15 Typical High $69.18 | Professional | None | $33.88 | $37.15 | $69.18 |
Lucent Health Setting Professional Modifier None Typical Low $162.18 Median $162.18 Typical High $162.18 | Professional | None | $162.18 | $162.18 | $162.18 |
Providence Setting Facility Modifier None Typical Low $38.02 Median $66.07 Typical High $100.00 | Facility | None | $38.02 | $66.07 | $100.00 |
Providence Setting Professional Modifier None Typical Low $38.02 Median $38.02 Typical High $38.02 | Professional | None | $38.02 | $38.02 | $38.02 |
United Setting Facility Modifier None Typical Low $38.02 Median $38.02 Typical High $38.02 | Facility | None | $38.02 | $38.02 | $38.02 |
United Setting Professional Modifier None Typical Low $33.88 Median $37.15 Typical High $44.67 | Professional | None | $33.88 | $37.15 | $44.67 |
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 $18.62 Median $23.44 Typical High $48.98 | Facility | 52 · Reduced service | $18.62 | $23.44 | $48.98 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $7.59 Median $9.33 Typical High $19.50 | Facility | 53 · Discontinued | $7.59 | $9.33 | $19.50 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $5.62 Median $6.92 Typical High $14.45 | Facility | 55 · Aftercare only | $5.62 | $6.92 | $14.45 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $3.80 Median $4.68 Typical High $9.77 | Facility | 56 · Pre-op care only | $3.80 | $4.68 | $9.77 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $18.62 Median $19.05 Typical High $19.05 | Professional | 52 · Reduced service | $18.62 | $19.05 | $19.05 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $7.59 Median $7.59 Typical High $7.59 | Professional | 53 · Discontinued | $7.59 | $7.59 | $7.59 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $5.62 Median $5.75 Typical High $5.75 | Professional | 55 · Aftercare only | $5.62 | $5.75 | $5.75 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.80 Median $3.80 Typical High $3.80 | Professional | 56 · Pre-op care only | $3.80 | $3.80 | $3.80 |
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· 17th of 51
$38.02
AK $47.86HI $37.15
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.