How much rates vary
Facilitymedian $89 · 10th to 90th $56 to $155Professionalmedian $56 · 10th to 90th $54 to $240
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 $56.23 Median $67.61 Typical High $141.25 | Facility | None | $56.23 | $67.61 | $141.25 |
Aetna Setting Professional Modifier None Typical Low $56.23 Median $57.54 Typical High $77.62 | Professional | None | $56.23 | $57.54 | $77.62 |
Anthem BCBS Setting Facility Modifier None Typical Low $61.66 Median $93.33 Typical High $190.55 | Facility | None | $61.66 | $93.33 | $190.55 |
Anthem BCBS Setting Professional Modifier None Typical Low $54.95 Median $54.95 Typical High $75.86 | Professional | None | $54.95 | $54.95 | $75.86 |
Blue Shield Setting Facility Modifier None Typical Low $54.95 Median $61.66 Typical High $104.71 | Facility | None | $54.95 | $61.66 | $104.71 |
Blue Shield Setting Professional Modifier None Typical Low $56.23 Median $56.23 Typical High $69.18 | Professional | None | $56.23 | $56.23 | $69.18 |
Central California Alliance for Health Setting Professional Modifier None Typical Low $56.23 Median $61.66 Typical High $61.66 | Professional | None | $56.23 | $61.66 | $61.66 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $102.33 Typical High $141.25 | Facility | None | $56.23 | $102.33 | $141.25 |
Cigna Setting Professional Modifier None Typical Low $56.23 Median $56.23 Typical High $56.23 | Professional | None | $56.23 | $56.23 | $56.23 |
Contra Costa Health Setting Professional Modifier None Typical Low $52.48 Median $53.70 Typical High $64.57 | Professional | None | $52.48 | $53.70 | $64.57 |
Kaiser Permanente Setting Professional Modifier None Typical Low $50.12 Median $54.95 Typical High $100.00 | Professional | None | $50.12 | $54.95 | $100.00 |
Lucent Health Setting Professional Modifier None Typical Low $239.88 Median $239.88 Typical High $239.88 | Professional | None | $239.88 | $239.88 | $239.88 |
Providence Setting Facility Modifier None Typical Low $56.23 Median $102.33 Typical High $158.49 | Facility | None | $56.23 | $102.33 | $158.49 |
Providence Setting Professional Modifier None Typical Low $56.23 Median $56.23 Typical High $56.23 | Professional | None | $56.23 | $56.23 | $56.23 |
United Setting Facility Modifier None Typical Low $56.23 Median $56.23 Typical High $56.23 | Facility | None | $56.23 | $56.23 | $56.23 |
United Setting Professional Modifier None Typical Low $46.77 Median $53.70 Typical High $64.57 | Professional | None | $46.77 | $53.70 | $64.57 |
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 $28.18 Median $33.88 Typical High $70.79 | Facility | 52 · Reduced service | $28.18 | $33.88 | $70.79 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $11.22 Median $13.49 Typical High $28.18 | Facility | 53 · Discontinued | $11.22 | $13.49 | $28.18 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $8.51 Median $10.00 Typical High $20.89 | Facility | 55 · Aftercare only | $8.51 | $10.00 | $20.89 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $5.62 Median $6.76 Typical High $14.13 | Facility | 56 · Pre-op care only | $5.62 | $6.76 | $14.13 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $28.18 Median $28.18 Typical High $28.18 | Professional | 52 · Reduced service | $28.18 | $28.18 | $28.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $11.22 Median $11.48 Typical High $11.48 | Professional | 53 · Discontinued | $11.22 | $11.48 | $11.48 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $8.51 Median $8.51 Typical High $8.51 | Professional | 55 · Aftercare only | $8.51 | $8.51 | $8.51 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.62 Median $5.75 Typical High $5.75 | Professional | 56 · Pre-op care only | $5.62 | $5.75 | $5.75 |
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· 31st of 51
$56.23
AK $69.18AL $56.23
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.