How much rates vary
Facilitymedian $47 · 10th to 90th $27 to $81Professionalmedian $26 · 10th to 90th $26 to $60
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 $25.70 Median $32.36 Typical High $66.07 | Facility | None | $25.70 | $32.36 | $66.07 |
Aetna Setting Professional Modifier None Typical Low $25.70 Median $27.54 Typical High $38.90 | Professional | None | $25.70 | $27.54 | $38.90 |
Ambetter Setting Professional Modifier None Typical Low $60.26 Median $60.26 Typical High $60.26 | Professional | None | $60.26 | $60.26 | $60.26 |
Anthem BCBS Setting Facility Modifier None Typical Low $28.18 Median $43.65 Typical High $89.13 | Facility | None | $28.18 | $43.65 | $89.13 |
Anthem BCBS Setting Professional Modifier None Typical Low $25.70 Median $25.70 Typical High $47.86 | Professional | None | $25.70 | $25.70 | $47.86 |
Blue Shield Setting Facility Modifier None Typical Low $34.67 Median $63.10 Typical High $81.28 | Facility | None | $34.67 | $63.10 | $81.28 |
Blue Shield Setting Professional Modifier None Typical Low $28.18 Median $28.18 Typical High $35.48 | Professional | None | $28.18 | $28.18 | $35.48 |
Central California Alliance for Health Setting Professional Modifier None Typical Low $25.70 Median $28.18 Typical High $28.18 | Professional | None | $25.70 | $28.18 | $28.18 |
Cigna Setting Facility Modifier None Typical Low $25.70 Median $40.74 Typical High $64.57 | Facility | None | $25.70 | $40.74 | $64.57 |
Cigna Setting Professional Modifier None Typical Low $25.70 Median $25.70 Typical High $25.70 | Professional | None | $25.70 | $25.70 | $25.70 |
Contra Costa Health Setting Professional Modifier None Typical Low $25.70 Median $25.70 Typical High $30.90 | Professional | None | $25.70 | $25.70 | $30.90 |
Kaiser Permanente Setting Professional Modifier None Typical Low $23.44 Median $25.70 Typical High $56.23 | Professional | None | $23.44 | $25.70 | $56.23 |
Lucent Health Setting Professional Modifier None Typical Low $114.82 Median $114.82 Typical High $114.82 | Professional | None | $114.82 | $114.82 | $114.82 |
Molina Setting Professional Modifier None Typical Low $22.91 Median $22.91 Typical High $22.91 | Professional | None | $22.91 | $22.91 | $22.91 |
Providence Setting Facility Modifier None Typical Low $25.70 Median $40.74 Typical High $69.18 | Facility | None | $25.70 | $40.74 | $69.18 |
Providence Setting Professional Modifier None Typical Low $25.70 Median $25.70 Typical High $25.70 | Professional | None | $25.70 | $25.70 | $25.70 |
Sutter Health Plus Setting Professional Modifier None Typical Low $141.25 Median $141.25 Typical High $141.25 | Professional | None | $141.25 | $141.25 | $141.25 |
United Setting Facility Modifier None Typical Low $25.70 Median $25.70 Typical High $213.80 | Facility | None | $25.70 | $25.70 | $213.80 |
United Setting Professional Modifier None Typical Low $22.91 Median $25.70 Typical High $30.90 | Professional | None | $22.91 | $25.70 | $30.90 |
10 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 Facility Modifier 52 · Reduced service Typical Low $12.88 Median $13.80 Typical High $32.36 | Facility | 52 · Reduced service | $12.88 | $13.80 | $32.36 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $5.13 Median $5.50 Typical High $13.18 | Facility | 53 · Discontinued | $5.13 | $5.50 | $13.18 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $3.89 Median $4.17 Typical High $9.77 | Facility | 55 · Aftercare only | $3.89 | $4.17 | $9.77 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $2.57 Median $2.75 Typical High $6.61 | Facility | 56 · Pre-op care only | $2.57 | $2.75 | $6.61 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $12.88 Median $13.18 Typical High $13.18 | Professional | 52 · Reduced service | $12.88 | $13.18 | $13.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $5.13 Median $5.25 Typical High $5.25 | Professional | 53 · Discontinued | $5.13 | $5.25 | $5.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $3.89 Median $3.89 Typical High $3.89 | Professional | 55 · Aftercare only | $3.89 | $3.89 | $3.89 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.57 Median $2.63 Typical High $2.63 | Professional | 56 · Pre-op care only | $2.57 | $2.63 | $2.63 |
Ambetter Setting Professional Modifier JW · Drug discarded Typical Low $19.50 Median $19.50 Typical High $19.50 | Professional | JW · Drug discarded | $19.50 | $19.50 | $19.50 |
Ambetter Setting Professional Modifier JZ · No drug discarded Typical Low $38.90 Median $38.90 Typical High $38.90 | Professional | JZ · No drug discarded | $38.90 | $38.90 | $38.90 |
Where California sits
Rates are fairly even across states for this service. 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· 16th of 51
$26.30
WY $36.31NC $25.12
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.