How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 $0.25 Median $0.25 Typical High $0.28 | Facility | None | $0.25 | $0.25 | $0.28 |
Aetna Setting Professional Modifier None Typical Low $0.24 Median $0.26 Typical High $0.28 | Professional | None | $0.24 | $0.26 | $0.28 |
Anthem BCBS Setting Professional Modifier None Typical Low $0.20 Median $0.21 Typical High $0.31 | Professional | None | $0.20 | $0.21 | $0.31 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $0.15 Median $0.16 Typical High $0.20 | Professional | UE · Used equipment | $0.15 | $0.16 | $0.20 |
CareSource Setting Facility Modifier None Typical Low $0.44 Median $0.44 Typical High $0.44 | Facility | None | $0.44 | $0.44 | $0.44 |
CareSource Setting Professional Modifier None Typical Low $0.47 Median $0.55 Typical High $0.71 | Professional | None | $0.47 | $0.55 | $0.71 |
Cigna Setting Facility Modifier None Typical Low $0.62 Median $0.62 Typical High $0.62 | Facility | None | $0.62 | $0.62 | $0.62 |
Cigna Setting Professional Modifier None Typical Low $0.22 Median $0.22 Typical High $2.19 | Professional | None | $0.22 | $0.22 | $2.19 |
Molina Setting Professional Modifier None Typical Low $0.27 Median $0.63 Typical High $0.63 | Professional | None | $0.27 | $0.63 | $0.63 |
United Setting Professional Modifier None Typical Low $0.15 Median $0.20 Typical High $0.27 | Professional | None | $0.15 | $0.20 | $0.27 |
4 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 $0.12 Median $0.13 Typical High $0.14 | Professional | 52 · Reduced service | $0.12 | $0.13 | $0.14 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.05 Median $0.05 Typical High $0.06 | Professional | 53 · Discontinued | $0.05 | $0.05 | $0.06 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.04 Median $0.04 Typical High $0.04 | Professional | 55 · Aftercare only | $0.04 | $0.04 | $0.04 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.02 Median $0.03 Typical High $0.03 | Professional | 56 · Pre-op care only | $0.02 | $0.03 | $0.03 |
Where Kentucky sits
The same service costs 2.5 times more in Hawaii than in Utah. 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.
Kentucky· 49th of 51
$0.22
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.