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 $0.78 Median $0.78 Typical High $0.78 | Facility | None | $0.78 | $0.78 | $0.78 |
Aetna Setting Professional Modifier None Typical Low $0.54 Median $0.78 Typical High $0.78 | Professional | None | $0.54 | $0.78 | $0.78 |
Ambetter Setting Professional Modifier None Typical Low $63.10 Median $63.10 Typical High $63.10 | Professional | None | $63.10 | $63.10 | $63.10 |
BCBS Setting Facility Modifier None Typical Low $0.72 Median $0.91 Typical High $1.20 | Facility | None | $0.72 | $0.91 | $1.20 |
BCBS Setting Professional Modifier None Typical Low $0.65 Median $0.68 Typical High $0.72 | Professional | None | $0.65 | $0.68 | $0.72 |
Cigna Setting Professional Modifier None Typical Low $0.45 Median $0.45 Typical High $0.45 | Professional | None | $0.45 | $0.45 | $0.45 |
Medcost Setting Professional Modifier None Typical Low $0.62 Median $0.62 Typical High $0.62 | Professional | None | $0.62 | $0.62 | $0.62 |
Medcost Setting Facility Modifier None Typical Low $0.78 Median $1.07 Typical High $1.23 | Facility | None | $0.78 | $1.07 | $1.23 |
Medcost Setting Professional Modifier None Typical Low $0.65 Median $0.65 Typical High $1.62 | Professional | None | $0.65 | $0.65 | $1.62 |
United Setting Professional Modifier None Typical Low $0.31 Median $0.43 Typical High $0.49 | Professional | None | $0.31 | $0.43 | $0.49 |
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 $0.28 Median $0.39 Typical High $0.39 | Professional | 52 · Reduced service | $0.28 | $0.39 | $0.39 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.11 Median $0.15 Typical High $0.15 | Professional | 53 · Discontinued | $0.11 | $0.15 | $0.15 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.08 Median $0.12 Typical High $0.12 | Professional | 55 · Aftercare only | $0.08 | $0.12 | $0.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.06 Median $0.08 Typical High $0.08 | Professional | 56 · Pre-op care only | $0.06 | $0.08 | $0.08 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $0.32 Median $0.32 Typical High $1.07 | Professional | 51 · Multiple procedures | $0.32 | $0.32 | $1.07 |
Where North Carolina 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.
North Carolina· 18th of 51
$0.68
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.