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 Professional Modifier None Typical Low $38.90 Median $54.95 Typical High $77.62 | Professional | None | $38.90 | $54.95 | $77.62 |
Cigna Setting Facility Modifier None Typical Low $64.57 Median $64.57 Typical High $64.57 | Facility | None | $64.57 | $64.57 | $64.57 |
Cigna Setting Professional Modifier None Typical Low $120.23 Median $120.23 Typical High $120.23 | Professional | None | $120.23 | $120.23 | $120.23 |
HMSA Setting Professional Modifier None Typical Low $109.65 Median $114.82 Typical High $114.82 | Professional | None | $109.65 | $114.82 | $114.82 |
Kaiser Permanente Setting Professional Modifier None Typical Low $77.62 Median $93.33 Typical High $213.80 | Professional | None | $77.62 | $93.33 | $213.80 |
United Setting Professional Modifier None Typical Low $64.57 Median $120.23 Typical High $120.23 | Professional | None | $64.57 | $120.23 | $120.23 |
University Health Alliance Setting Professional Modifier None Typical Low $93.33 Median $93.33 Typical High $109.65 | Professional | None | $93.33 | $93.33 | $109.65 |
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 $19.50 Median $27.54 Typical High $38.90 | Professional | 52 · Reduced service | $19.50 | $27.54 | $38.90 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $7.76 Median $10.96 Typical High $15.49 | Professional | 53 · Discontinued | $7.76 | $10.96 | $15.49 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $5.75 Median $8.32 Typical High $11.75 | Professional | 55 · Aftercare only | $5.75 | $8.32 | $11.75 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.89 Median $5.50 Typical High $7.76 | Professional | 56 · Pre-op care only | $3.89 | $5.50 | $7.76 |
Where Hawaii sits
The same service costs 2.5 times more in Hawaii than in Rhode Island. 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.
Hawaii· 1st of 51
$115
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.