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 $28.84 Median $28.84 Typical High $32.36 | Professional | None | $28.84 | $28.84 | $32.36 |
Cigna Setting Professional Modifier None Typical Low $32.36 Median $32.36 Typical High $32.36 | Professional | None | $32.36 | $32.36 | $32.36 |
HMSA Setting Professional Modifier None Typical Low $35.48 Median $35.48 Typical High $35.48 | Professional | None | $35.48 | $35.48 | $35.48 |
Kaiser Permanente Setting Professional Modifier None Typical Low $28.84 Median $33.88 Typical High $42.66 | Professional | None | $28.84 | $33.88 | $42.66 |
United Setting Professional Modifier None Typical Low $28.84 Median $32.36 Typical High $32.36 | Professional | None | $28.84 | $32.36 | $32.36 |
University Health Alliance Setting Professional Modifier None Typical Low $34.67 Median $34.67 Typical High $42.66 | Professional | None | $34.67 | $34.67 | $42.66 |
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 $14.13 Median $14.45 Typical High $16.22 | Professional | 52 · Reduced service | $14.13 | $14.45 | $16.22 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $5.75 Median $5.75 Typical High $6.46 | Professional | 53 · Discontinued | $5.75 | $5.75 | $6.46 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $4.27 Median $4.37 Typical High $4.90 | Professional | 55 · Aftercare only | $4.27 | $4.37 | $4.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.82 Median $2.88 Typical High $3.24 | Professional | 56 · Pre-op care only | $2.82 | $2.88 | $3.24 |
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· 8th of 51
$32.36
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.