How much rates vary
Facilitymedian $6 · 10th to 90th $4 to $22Professionalmedian $6 · 10th to 90th $4 to $89
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 $6.46 Median $6.46 Typical High $6.46 | Facility | None | $6.46 | $6.46 | $6.46 |
Aetna Setting Professional Modifier None Typical Low $6.46 Median $6.46 Typical High $7.41 | Professional | None | $6.46 | $6.46 | $7.41 |
Ambetter Setting Professional Modifier None Typical Low $13.80 Median $13.80 Typical High $13.80 | Professional | None | $13.80 | $13.80 | $13.80 |
Anthem BCBS Setting Facility Modifier None Typical Low $4.17 Median $5.25 Typical High $21.88 | Facility | None | $4.17 | $5.25 | $21.88 |
Anthem BCBS Setting Professional Modifier None Typical Low $4.17 Median $4.17 Typical High $12.02 | Professional | None | $4.17 | $4.17 | $12.02 |
Blue Shield Setting Professional Modifier None Typical Low $8.51 Median $13.18 Typical High $27.54 | Professional | None | $8.51 | $13.18 | $27.54 |
Cigna Setting Professional Modifier None Typical Low $4.90 Median $4.90 Typical High $4.90 | Professional | None | $4.90 | $4.90 | $4.90 |
Contra Costa Health Setting Professional Modifier None Typical Low $12.02 Median $13.18 Typical High $16.22 | Professional | None | $12.02 | $13.18 | $16.22 |
Kaiser Permanente Setting Professional Modifier None Typical Low $10.72 Median $13.80 Typical High $33.11 | Professional | None | $10.72 | $13.80 | $33.11 |
Lucent Health Setting Professional Modifier None Typical Low $89.13 Median $144.54 Typical High $144.54 | Professional | None | $89.13 | $144.54 | $144.54 |
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 $6.46 Median $12.02 Typical High $33.11 | Facility | None | $6.46 | $12.02 | $33.11 |
Providence Setting Professional Modifier None Typical Low $4.90 Median $4.90 Typical High $4.90 | Professional | None | $4.90 | $4.90 | $4.90 |
Sutter Health Plus Setting Professional Modifier None Typical Low $21.88 Median $21.88 Typical High $21.88 | Professional | None | $21.88 | $21.88 | $21.88 |
United Setting Professional Modifier None Typical Low $4.68 Median $5.01 Typical High $14.79 | Professional | None | $4.68 | $5.01 | $14.79 |
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 $3.24 Typical High $3.55 | Professional | 52 · Reduced service | $3.24 | $3.24 | $3.55 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.29 Median $1.29 Typical High $1.45 | Professional | 53 · Discontinued | $1.29 | $1.29 | $1.45 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $4.79 Median $4.79 Typical High $5.37 | Professional | 54 · Surgery only | $4.79 | $4.79 | $5.37 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.98 Median $0.98 Typical High $1.07 | Professional | 55 · Aftercare only | $0.98 | $0.98 | $1.07 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.65 Median $0.65 Typical High $0.71 | Professional | 56 · Pre-op care only | $0.65 | $0.65 | $0.71 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $0.89 Median $1.17 Typical High $5.37 | Professional | RR · Rental | $0.89 | $1.17 | $5.37 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $6.76 Median $8.71 Typical High $40.74 | Professional | UE · Used equipment | $6.76 | $8.71 | $40.74 |
Where California sits
The same service costs 2.9 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· 40th of 51
$6.03
RI $13.49NY $4.68
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.