How much rates vary
Facilitymedian $15 · 10th to 90th $13 to $62Professionalmedian $17 · 10th to 90th $12 to $209
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 $14.13 Median $14.13 Typical High $14.13 | Facility | None | $14.13 | $14.13 | $14.13 |
Aetna Setting Professional Modifier None Typical Low $14.13 Median $14.13 Typical High $14.13 | Professional | None | $14.13 | $14.13 | $14.13 |
Ambetter Setting Professional Modifier None Typical Low $19.05 Median $22.91 Typical High $25.70 | Professional | None | $19.05 | $22.91 | $25.70 |
Anthem BCBS Setting Facility Modifier None Typical Low $11.22 Median $52.48 Typical High $104.71 | Facility | None | $11.22 | $52.48 | $104.71 |
Anthem BCBS Setting Professional Modifier None Typical Low $17.78 Median $19.50 Typical High $44.67 | Professional | None | $17.78 | $19.50 | $44.67 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $14.13 Median $14.13 Typical High $18.62 | Professional | RR · Rental | $14.13 | $14.13 | $18.62 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $10.72 Median $10.72 Typical High $13.49 | Professional | UE · Used equipment | $10.72 | $10.72 | $13.49 |
Blue Shield Setting Facility Modifier None Typical Low $30.20 Median $45.71 Typical High $75.86 | Facility | None | $30.20 | $45.71 | $75.86 |
Blue Shield Setting Professional Modifier None Typical Low $34.67 Median $66.07 Typical High $117.49 | Professional | None | $34.67 | $66.07 | $117.49 |
Central California Alliance for Health Setting Professional Modifier None Typical Low $11.75 Median $12.88 Typical High $25.12 | Professional | None | $11.75 | $12.88 | $25.12 |
Cigna Setting Facility Modifier None Typical Low $16.22 Median $16.22 Typical High $16.22 | Facility | None | $16.22 | $16.22 | $16.22 |
Cigna Setting Professional Modifier None Typical Low $12.02 Median $12.02 Typical High $16.22 | Professional | None | $12.02 | $12.02 | $16.22 |
Contra Costa Health Setting Professional Modifier None Typical Low $11.75 Median $31.62 Typical High $34.67 | Professional | None | $11.75 | $31.62 | $34.67 |
Kaiser Permanente Setting Professional Modifier None Typical Low $19.05 Median $26.92 Typical High $72.44 | Professional | None | $19.05 | $26.92 | $72.44 |
Lucent Health Setting Professional Modifier None Typical Low $151.36 Median $151.36 Typical High $208.93 | Professional | None | $151.36 | $151.36 | $208.93 |
Molina Setting Professional Modifier None Typical Low $36.31 Median $36.31 Typical High $36.31 | Professional | None | $36.31 | $36.31 | $36.31 |
Optum Setting Professional Modifier None Typical Low $54.95 Median $54.95 Typical High $70.79 | Professional | None | $54.95 | $54.95 | $70.79 |
Providence Setting Facility Modifier None Typical Low $7.76 Median $16.22 Typical High $31.62 | Facility | None | $7.76 | $16.22 | $31.62 |
Providence Setting Professional Modifier None Typical Low $12.02 Median $12.02 Typical High $16.22 | Professional | None | $12.02 | $12.02 | $16.22 |
Sutter Health Plus Setting Professional Modifier None Typical Low $58.88 Median $58.88 Typical High $58.88 | Professional | None | $58.88 | $58.88 | $58.88 |
United Setting Facility Modifier None Typical Low $12.88 Median $15.49 Typical High $15.49 | Facility | None | $12.88 | $15.49 | $15.49 |
United Setting Professional Modifier None Typical Low $11.22 Median $15.49 Typical High $39.81 | Professional | None | $11.22 | $15.49 | $39.81 |
4 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 Professional Modifier 52 · Reduced service Typical Low $7.08 Median $7.08 Typical High $7.08 | Professional | 52 · Reduced service | $7.08 | $7.08 | $7.08 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.82 Median $2.82 Typical High $2.82 | Professional | 53 · Discontinued | $2.82 | $2.82 | $2.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.09 Median $2.09 Typical High $2.09 | Professional | 55 · Aftercare only | $2.09 | $2.09 | $2.09 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.41 Median $1.41 Typical High $1.41 | Professional | 56 · Pre-op care only | $1.41 | $1.41 | $1.41 |
Where California sits
The same service costs 3.0 times more in Hawaii than in Delaware. 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· 34th of 51
$16.22
HI $35.48DE $12.02
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.