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 $1,513.56 Median $4,365.16 Typical High $8,128.31 | Facility | None | $1,513.56 | $4,365.16 | $8,128.31 |
Aetna Setting Professional Modifier None Typical Low $42.66 Median $42.66 Typical High $144.54 | Professional | None | $42.66 | $42.66 | $144.54 |
Anthem BCBS Setting Facility Modifier None Typical Low $933.25 Median $3,162.28 Typical High $4,897.79 | Facility | None | $933.25 | $3,162.28 | $4,897.79 |
Anthem BCBS Setting Professional Modifier None Typical Low $34.67 Median $41.69 Typical High $70.79 | Professional | None | $34.67 | $41.69 | $70.79 |
CDPHP Setting Professional Modifier None Typical Low $57.54 Median $57.54 Typical High $57.54 | Professional | None | $57.54 | $57.54 | $57.54 |
Cigna Setting Facility Modifier None Typical Low $58.88 Median $100.00 Typical High $1,096.48 | Facility | None | $58.88 | $100.00 | $1,096.48 |
Cigna Setting Professional Modifier None Typical Low $30.90 Median $33.88 Typical High $125.89 | Professional | None | $30.90 | $33.88 | $125.89 |
Emblem Health Setting Facility Modifier None Typical Low $38.02 Median $70.79 Typical High $144.54 | Facility | None | $38.02 | $70.79 | $144.54 |
Emblem Health Setting Professional Modifier None Typical Low $36.31 Median $39.81 Typical High $70.79 | Professional | None | $36.31 | $39.81 | $70.79 |
Excellus BCBS Setting Professional Modifier None Typical Low $25.12 Median $31.62 Typical High $56.23 | Professional | None | $25.12 | $31.62 | $56.23 |
MVP Health Care Setting Facility Modifier None Typical Low $35.48 Median $35.48 Typical High $39.81 | Facility | None | $35.48 | $35.48 | $39.81 |
MVP Health Care Setting Professional Modifier None Typical Low $38.02 Median $38.02 Typical High $97.72 | Professional | None | $38.02 | $38.02 | $97.72 |
United Setting Facility Modifier None Typical Low $363.08 Median $1,258.93 Typical High $4,365.16 | Facility | None | $363.08 | $1,258.93 | $4,365.16 |
United Setting Professional Modifier None Typical Low $26.92 Median $42.66 Typical High $112.20 | Professional | None | $26.92 | $42.66 | $112.20 |
Univera Setting Facility Modifier None Typical Low $28.18 Median $36.31 Typical High $186.21 | Facility | None | $28.18 | $36.31 | $186.21 |
Univera Setting Professional Modifier None Typical Low $25.12 Median $31.62 Typical High $56.23 | Professional | None | $25.12 | $31.62 | $56.23 |
5 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 $21.38 Median $21.38 Typical High $26.92 | Professional | 52 · Reduced service | $21.38 | $21.38 | $26.92 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $8.51 Median $8.51 Typical High $10.72 | Professional | 53 · Discontinued | $8.51 | $8.51 | $10.72 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $32.36 Median $32.36 Typical High $40.74 | Professional | 54 · Surgery only | $32.36 | $32.36 | $40.74 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $6.46 Median $6.46 Typical High $8.13 | Professional | 55 · Aftercare only | $6.46 | $6.46 | $8.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.27 Median $4.27 Typical High $5.37 | Professional | 56 · Pre-op care only | $4.27 | $4.27 | $5.37 |
Where New York sits
The same service costs 9.3 times more in Tennessee 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.
New York· 51st of 51
$42.66
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.