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 $204.17 Median $204.17 Typical High $204.17 | Facility | None | $204.17 | $204.17 | $204.17 |
Aetna Setting Professional Modifier None Typical Low $194.98 Median $204.17 Typical High $204.17 | Professional | None | $194.98 | $204.17 | $204.17 |
Anthem BCBS Setting Professional Modifier None Typical Low $199.53 Median $389.05 Typical High $588.84 | Professional | None | $199.53 | $389.05 | $588.84 |
Cigna Setting Facility Modifier None Typical Low $630.96 Median $724.44 Typical High $1,071.52 | Facility | None | $630.96 | $724.44 | $1,071.52 |
Cigna Setting Professional Modifier None Typical Low $181.97 Median $263.03 Typical High $588.84 | Professional | None | $181.97 | $263.03 | $588.84 |
DeanCare Setting Facility Modifier None Typical Low $194.98 Median $213.80 Typical High $346.74 | Facility | None | $194.98 | $213.80 | $346.74 |
Medica Setting Facility Modifier None Typical Low $194.98 Median $257.04 Typical High $1,148.15 | Facility | None | $194.98 | $257.04 | $1,148.15 |
Medica Setting Professional Modifier None Typical Low $208.93 Median $338.84 Typical High $870.96 | Professional | None | $208.93 | $338.84 | $870.96 |
Prevea360 Setting Facility Modifier None Typical Low $194.98 Median $213.80 Typical High $346.74 | Facility | None | $194.98 | $213.80 | $346.74 |
Quartz Setting Professional Modifier None Typical Low $102.33 Median $489.78 Typical High $562.34 | Professional | None | $102.33 | $489.78 | $562.34 |
Quartz Setting Professional Modifier None Typical Low $181.97 Median $181.97 Typical High $181.97 | Professional | None | $181.97 | $181.97 | $181.97 |
United Setting Professional Modifier None Typical Low $208.93 Median $537.03 Typical High $891.25 | Professional | None | $208.93 | $537.03 | $891.25 |
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 $95.50 Median $102.33 Typical High $102.33 | Professional | 52 · Reduced service | $95.50 | $102.33 | $102.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $38.90 Median $40.74 Typical High $40.74 | Professional | 53 · Discontinued | $38.90 | $40.74 | $40.74 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $28.84 Median $30.90 Typical High $30.90 | Professional | 55 · Aftercare only | $28.84 | $30.90 | $30.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.50 Median $20.42 Typical High $20.42 | Professional | 56 · Pre-op care only | $19.50 | $20.42 | $20.42 |
Where Wisconsin sits
The same service costs 6.6 times more in Alabama 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.
Wisconsin· 4th of 51
$339
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.