How much rates vary
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 $0.85 Median $0.85 Typical High $0.85 | Facility | None | $0.85 | $0.85 | $0.85 |
Aetna Setting Professional Modifier None Typical Low $0.85 Median $0.85 Typical High $0.85 | Professional | None | $0.85 | $0.85 | $0.85 |
Anthem BCBS Setting Facility Modifier None Typical Low $0.87 Median $1.00 Typical High $1.26 | Facility | None | $0.87 | $1.00 | $1.26 |
Anthem BCBS Setting Professional Modifier None Typical Low $0.87 Median $0.87 Typical High $1.12 | Professional | None | $0.87 | $0.87 | $1.12 |
Blue Shield Setting Facility Modifier None Typical Low $85.11 Median $128.82 Typical High $275.42 | Facility | None | $85.11 | $128.82 | $275.42 |
Blue Shield Setting Professional Modifier None Typical Low $39.81 Median $39.81 Typical High $39.81 | Professional | None | $39.81 | $39.81 | $39.81 |
Central California Alliance for Health Setting Professional Modifier None Typical Low $0.85 Median $0.85 Typical High $1.02 | Professional | None | $0.85 | $0.85 | $1.02 |
Contra Costa Health Setting Professional Modifier None Typical Low $5.37 Median $5.37 Typical High $6.31 | Professional | None | $5.37 | $5.37 | $6.31 |
Kaiser Permanente Setting Professional Modifier None Typical Low $128.82 Median $630.96 Typical High $831.76 | Professional | None | $128.82 | $630.96 | $831.76 |
Lucent Health Setting Professional Modifier None Typical Low $60.26 Median $141.25 Typical High $141.25 | Professional | None | $60.26 | $141.25 | $141.25 |
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 $0.85 Median $1.23 Typical High $1.23 | Facility | None | $0.85 | $1.23 | $1.23 |
Providence Setting Professional Modifier None Typical Low $60.26 Median $79.43 Typical High $89.13 | Professional | None | $60.26 | $79.43 | $89.13 |
United Setting Facility Modifier None Typical Low $89.13 Median $89.13 Typical High $138.04 | Facility | None | $89.13 | $89.13 | $138.04 |
United Setting Professional Modifier None Typical Low $3.31 Median $3.31 Typical High $44.67 | Professional | None | $3.31 | $3.31 | $44.67 |
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 $0.43 Median $0.43 Typical High $0.43 | Professional | 52 · Reduced service | $0.43 | $0.43 | $0.43 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.17 Median $0.17 Typical High $0.17 | Professional | 53 · Discontinued | $0.17 | $0.17 | $0.17 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.13 Median $0.13 Typical High $0.13 | Professional | 55 · Aftercare only | $0.13 | $0.13 | $0.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.09 Median $0.09 Typical High $0.09 | Professional | 56 · Pre-op care only | $0.09 | $0.09 | $0.09 |
Where California sits
The same service costs 173.8 times more in Missouri than in Illinois. 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· 23rd of 51
$1.17
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.