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 $0.30 Median $0.35 Typical High $0.35 | Facility | None | $0.30 | $0.35 | $0.35 |
Aetna Setting Professional Modifier None Typical Low $0.30 Median $0.34 Typical High $0.35 | Professional | None | $0.30 | $0.34 | $0.35 |
Ambetter Setting Professional Modifier None Typical Low $40.74 Median $40.74 Typical High $40.74 | Professional | None | $40.74 | $40.74 | $40.74 |
Anthem BCBS Setting Professional Modifier None Typical Low $0.21 Median $0.25 Typical High $0.38 | Professional | None | $0.21 | $0.25 | $0.38 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $0.19 Median $0.28 Typical High $0.28 | Professional | UE · Used equipment | $0.19 | $0.28 | $0.28 |
CareSource Setting Facility Modifier None Typical Low $0.45 Median $0.54 Typical High $0.76 | Facility | None | $0.45 | $0.54 | $0.76 |
CareSource Setting Professional Modifier None Typical Low $0.54 Median $0.58 Typical High $0.76 | Professional | None | $0.54 | $0.58 | $0.76 |
Cigna Setting Facility Modifier None Typical Low $0.76 Median $0.76 Typical High $0.76 | Facility | None | $0.76 | $0.76 | $0.76 |
Cigna Setting Professional Modifier None Typical Low $0.28 Median $0.28 Typical High $2.63 | Professional | None | $0.28 | $0.28 | $2.63 |
Molina Setting Professional Modifier None Typical Low $0.34 Median $0.78 Typical High $0.78 | Professional | None | $0.34 | $0.78 | $0.78 |
United Setting Professional Modifier None Typical Low $0.18 Median $0.26 Typical High $0.35 | Professional | None | $0.18 | $0.26 | $0.35 |
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 $0.15 Median $0.16 Typical High $0.18 | Professional | 52 · Reduced service | $0.15 | $0.16 | $0.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.06 Median $0.06 Typical High $0.07 | Professional | 53 · Discontinued | $0.06 | $0.06 | $0.07 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.05 Median $0.05 Typical High $0.05 | Professional | 55 · Aftercare only | $0.05 | $0.05 | $0.05 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.03 Median $0.03 Typical High $0.04 | Professional | 56 · Pre-op care only | $0.03 | $0.03 | $0.04 |
Where Kentucky sits
The same service costs 2.6 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· 38th of 51
$0.28
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.