How much rates vary
Facilitymedian $7 · 10th to 90th $5 to $28Professionalmedian $14 · 10th to 90th $5 to $158
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 $13.80 Typical High $13.80 | Facility | None | $13.80 | $13.80 | $13.80 |
Aetna Setting Professional Modifier None Typical Low $13.80 Median $13.80 Typical High $20.42 | Professional | None | $13.80 | $13.80 | $20.42 |
Ambetter Setting Professional Modifier None Typical Low $13.18 Median $75.86 Typical High $75.86 | Professional | None | $13.18 | $75.86 | $75.86 |
Anthem BCBS Setting Facility Modifier None Typical Low $5.37 Median $6.92 Typical High $28.18 | Facility | None | $5.37 | $6.92 | $28.18 |
Anthem BCBS Setting Professional Modifier None Typical Low $5.50 Median $5.50 Typical High $15.49 | Professional | None | $5.50 | $5.50 | $15.49 |
Blue Shield Setting Professional Modifier None Typical Low $10.96 Median $16.98 Typical High $36.31 | Professional | None | $10.96 | $16.98 | $36.31 |
Cigna Setting Professional Modifier None Typical Low $6.31 Median $6.31 Typical High $6.31 | Professional | None | $6.31 | $6.31 | $6.31 |
Contra Costa Health Setting Professional Modifier None Typical Low $15.49 Median $16.98 Typical High $20.89 | Professional | None | $15.49 | $16.98 | $20.89 |
Kaiser Permanente Setting Professional Modifier None Typical Low $13.80 Median $18.62 Typical High $52.48 | Professional | None | $13.80 | $18.62 | $52.48 |
Lucent Health Setting Professional Modifier None Typical Low $158.49 Median $302.00 Typical High $302.00 | Professional | None | $158.49 | $302.00 | $302.00 |
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 $13.80 Median $15.49 Typical High $70.79 | Facility | None | $13.80 | $15.49 | $70.79 |
Providence Setting Professional Modifier None Typical Low $6.31 Median $6.31 Typical High $6.31 | Professional | None | $6.31 | $6.31 | $6.31 |
Sutter Health Plus Setting Professional Modifier None Typical Low $28.84 Median $28.84 Typical High $28.84 | Professional | None | $28.84 | $28.84 | $28.84 |
United Setting Professional Modifier None Typical Low $6.17 Median $6.61 Typical High $19.50 | Professional | None | $6.17 | $6.61 | $19.50 |
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 $6.03 Median $6.92 Typical High $6.92 | Professional | 52 · Reduced service | $6.03 | $6.92 | $6.92 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.40 Median $2.82 Typical High $2.82 | Professional | 53 · Discontinued | $2.40 | $2.82 | $2.82 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $9.12 Median $10.47 Typical High $10.47 | Professional | 54 · Surgery only | $9.12 | $10.47 | $10.47 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.82 Median $2.09 Typical High $2.09 | Professional | 55 · Aftercare only | $1.82 | $2.09 | $2.09 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.20 Median $1.41 Typical High $1.41 | Professional | 56 · Pre-op care only | $1.20 | $1.41 | $1.41 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $1.15 Median $1.51 Typical High $7.08 | Professional | RR · Rental | $1.15 | $1.51 | $7.08 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $8.71 Median $11.48 Typical High $52.48 | Professional | UE · Used equipment | $8.71 | $11.48 | $52.48 |
Where California sits
The same service costs 4.5 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· 15th of 51
$13.80
RI $27.54NY $6.17
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.