How much rates vary
Facilitymedian $4 · 10th to 90th $3 to $17Professionalmedian $4 · 10th to 90th $3 to $62
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 $13.80 Median $14.13 Typical High $16.60 | Facility | None | $13.80 | $14.13 | $16.60 |
Aetna Setting Professional Modifier None Typical Low $11.75 Median $14.13 Typical High $16.98 | Professional | None | $11.75 | $14.13 | $16.98 |
Ambetter Setting Professional Modifier None Typical Low $6.17 Median $6.17 Typical High $6.17 | Professional | None | $6.17 | $6.17 | $6.17 |
Anthem BCBS Setting Facility Modifier None Typical Low $2.88 Median $3.63 Typical High $15.14 | Facility | None | $2.88 | $3.63 | $15.14 |
Anthem BCBS Setting Professional Modifier None Typical Low $2.95 Median $2.95 Typical High $8.32 | Professional | None | $2.95 | $2.95 | $8.32 |
Blue Shield Setting Professional Modifier None Typical Low $5.89 Median $9.12 Typical High $19.50 | Professional | None | $5.89 | $9.12 | $19.50 |
Cigna Setting Professional Modifier None Typical Low $3.39 Median $3.39 Typical High $3.39 | Professional | None | $3.39 | $3.39 | $3.39 |
Contra Costa Health Setting Professional Modifier None Typical Low $8.32 Median $9.12 Typical High $11.22 | Professional | None | $8.32 | $9.12 | $11.22 |
Kaiser Permanente Setting Professional Modifier None Typical Low $7.41 Median $10.72 Typical High $22.91 | Professional | None | $7.41 | $10.72 | $22.91 |
Lucent Health Setting Professional Modifier None Typical Low $61.66 Median $112.20 Typical High $112.20 | Professional | None | $61.66 | $112.20 | $112.20 |
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 $8.32 Median $14.13 Typical High $26.30 | Facility | None | $8.32 | $14.13 | $26.30 |
Providence Setting Professional Modifier None Typical Low $3.39 Median $3.39 Typical High $3.39 | Professional | None | $3.39 | $3.39 | $3.39 |
Sutter Health Plus Setting Professional Modifier None Typical Low $15.14 Median $15.14 Typical High $15.14 | Professional | None | $15.14 | $15.14 | $15.14 |
United Setting Professional Modifier None Typical Low $3.24 Median $3.55 Typical High $10.23 | Professional | None | $3.24 | $3.55 | $10.23 |
7 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 $3.24 Median $7.08 Typical High $8.13 | Professional | 52 · Reduced service | $3.24 | $7.08 | $8.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.29 Median $2.82 Typical High $3.31 | Professional | 53 · Discontinued | $1.29 | $2.82 | $3.31 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $4.79 Median $10.47 Typical High $12.30 | Professional | 54 · Surgery only | $4.79 | $10.47 | $12.30 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.95 Median $2.09 Typical High $2.45 | Professional | 55 · Aftercare only | $0.95 | $2.09 | $2.45 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.65 Median $1.41 Typical High $1.62 | Professional | 56 · Pre-op care only | $0.65 | $1.41 | $1.62 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $0.62 Median $0.81 Typical High $3.80 | Professional | RR · Rental | $0.62 | $0.81 | $3.80 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $4.37 Median $5.89 Typical High $28.18 | Professional | UE · Used equipment | $4.37 | $5.89 | $28.18 |
Where California sits
The same service costs 3.2 times more in Rhode Island than in New York. 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· 39th of 51
$4.17
RI $10.72NY $3.31
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.