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 $3.24 Median $3.24 Typical High $3.24 | Facility | None | $3.24 | $3.24 | $3.24 |
Aetna Setting Professional Modifier None Typical Low $3.24 Median $3.24 Typical High $3.47 | Professional | None | $3.24 | $3.24 | $3.47 |
Anthem BCBS Setting Facility Modifier None Typical Low $2.04 Median $2.57 Typical High $10.72 | Facility | None | $2.04 | $2.57 | $10.72 |
Anthem BCBS Setting Professional Modifier None Typical Low $2.04 Median $2.04 Typical High $5.75 | Professional | None | $2.04 | $2.04 | $5.75 |
Blue Shield Setting Professional Modifier None Typical Low $4.17 Median $6.46 Typical High $13.49 | Professional | None | $4.17 | $6.46 | $13.49 |
Cigna Setting Professional Modifier None Typical Low $2.34 Median $2.34 Typical High $2.34 | Professional | None | $2.34 | $2.34 | $2.34 |
Contra Costa Health Setting Professional Modifier None Typical Low $5.75 Median $6.31 Typical High $7.76 | Professional | None | $5.75 | $6.31 | $7.76 |
Kaiser Permanente Setting Professional Modifier None Typical Low $5.25 Median $6.61 Typical High $16.22 | Professional | None | $5.25 | $6.61 | $16.22 |
Lucent Health Setting Professional Modifier None Typical Low $43.65 Median $72.44 Typical High $72.44 | Professional | None | $43.65 | $72.44 | $72.44 |
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 $3.24 Median $5.75 Typical High $16.60 | Facility | None | $3.24 | $5.75 | $16.60 |
Providence Setting Professional Modifier None Typical Low $2.34 Median $2.34 Typical High $2.34 | Professional | None | $2.34 | $2.34 | $2.34 |
Sutter Health Plus Setting Professional Modifier None Typical Low $10.72 Median $10.72 Typical High $10.72 | Professional | None | $10.72 | $10.72 | $10.72 |
United Setting Professional Modifier None Typical Low $2.29 Median $2.45 Typical High $7.24 | Professional | None | $2.29 | $2.45 | $7.24 |
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 $1.62 Median $1.62 Typical High $1.74 | Professional | 52 · Reduced service | $1.62 | $1.62 | $1.74 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.65 Median $0.65 Typical High $0.71 | Professional | 53 · Discontinued | $0.65 | $0.65 | $0.71 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2.40 Median $2.40 Typical High $2.63 | Professional | 54 · Surgery only | $2.40 | $2.40 | $2.63 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.48 Median $0.48 Typical High $0.52 | Professional | 55 · Aftercare only | $0.48 | $0.48 | $0.52 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.32 Median $0.32 Typical High $0.35 | Professional | 56 · Pre-op care only | $0.32 | $0.32 | $0.35 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $0.43 Median $0.56 Typical High $2.63 | Professional | RR · Rental | $0.43 | $0.56 | $2.63 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $3.02 Median $4.17 Typical High $19.95 | Professional | UE · Used equipment | $3.02 | $4.17 | $19.95 |
Where California sits
The same service costs 3.0 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· 48th of 51
$2.40
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.