How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). 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 $144.54 Median $147.91 Typical High $199.53 | Professional | None | $144.54 | $147.91 | $199.53 |
Cigna Setting Professional Modifier None Typical Low $158.49 Median $158.49 Typical High $158.49 | Professional | None | $158.49 | $158.49 | $158.49 |
HMSA Setting Professional Modifier None Typical Low $131.83 Median $131.83 Typical High $131.83 | Professional | None | $131.83 | $131.83 | $131.83 |
Kaiser Permanente Setting Professional Modifier None Typical Low $138.04 Median $165.96 Typical High $204.17 | Professional | None | $138.04 | $165.96 | $204.17 |
United Setting Professional Modifier None Typical Low $138.04 Median $158.49 Typical High $158.49 | Professional | None | $138.04 | $158.49 | $158.49 |
University Health Alliance Setting Professional Modifier None Typical Low $134.90 Median $151.36 Typical High $204.17 | Professional | None | $134.90 | $151.36 | $204.17 |
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 $72.44 Median $72.44 Typical High $79.43 | Professional | 52 · Reduced service | $72.44 | $72.44 | $79.43 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $28.84 Median $28.84 Typical High $31.62 | Professional | 53 · Discontinued | $28.84 | $28.84 | $31.62 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $21.38 Median $21.38 Typical High $23.44 | Professional | 55 · Aftercare only | $21.38 | $21.38 | $23.44 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.45 Median $14.45 Typical High $15.85 | Professional | 56 · Pre-op care only | $14.45 | $14.45 | $15.85 |
Where Hawaii sits
Rates are fairly even across states for this service. 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· 7th of 51
$158
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.