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 $5.62 Median $7.59 Typical High $13.80 | Facility | None | $5.62 | $7.59 | $13.80 |
Aetna Setting Professional Modifier None Typical Low $5.62 Median $5.62 Typical High $7.59 | Professional | None | $5.62 | $5.62 | $7.59 |
Anthem BCBS Setting Professional Modifier None Typical Low $2.57 Median $3.09 Typical High $4.27 | Professional | None | $2.57 | $3.09 | $4.27 |
CDPHP Setting Professional Modifier None Typical Low $6.76 Median $6.76 Typical High $6.76 | Professional | None | $6.76 | $6.76 | $6.76 |
Cigna Setting Facility Modifier None Typical Low $11.22 Median $11.22 Typical High $11.22 | Facility | None | $11.22 | $11.22 | $11.22 |
Cigna Setting Professional Modifier None Typical Low $3.39 Median $3.39 Typical High $3.39 | Professional | None | $3.39 | $3.39 | $3.39 |
Emblem Health Setting Facility Modifier None Typical Low $8.32 Median $12.30 Typical High $29.51 | Facility | None | $8.32 | $12.30 | $29.51 |
Emblem Health Setting Professional Modifier None Typical Low $8.71 Median $10.00 Typical High $15.49 | Professional | None | $8.71 | $10.00 | $15.49 |
Excellus BCBS Setting Professional Modifier None Typical Low $6.76 Median $10.47 Typical High $11.22 | Professional | None | $6.76 | $10.47 | $11.22 |
MVP Health Care Setting Professional Modifier None Typical Low $8.91 Median $8.91 Typical High $12.02 | Professional | None | $8.91 | $8.91 | $12.02 |
United Setting Professional Modifier None Typical Low $2.69 Median $4.90 Typical High $6.31 | Professional | None | $2.69 | $4.90 | $6.31 |
Univera Setting Facility Modifier None Typical Low $10.47 Median $10.47 Typical High $10.47 | Facility | None | $10.47 | $10.47 | $10.47 |
Univera Setting Professional Modifier None Typical Low $5.75 Median $10.47 Typical High $11.22 | Professional | None | $5.75 | $10.47 | $11.22 |
7 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 $2.82 Median $2.82 Typical High $3.80 | Professional | 52 · Reduced service | $2.82 | $2.82 | $3.80 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.12 Median $1.12 Typical High $1.51 | Professional | 53 · Discontinued | $1.12 | $1.12 | $1.51 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $4.27 Median $4.27 Typical High $5.75 | Professional | 54 · Surgery only | $4.27 | $4.27 | $5.75 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.85 Median $0.85 Typical High $1.15 | Professional | 55 · Aftercare only | $0.85 | $0.85 | $1.15 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.56 Median $0.56 Typical High $0.78 | Professional | 56 · Pre-op care only | $0.56 | $0.56 | $0.78 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $0.68 Median $0.71 Typical High $0.83 | Professional | RR · Rental | $0.68 | $0.71 | $0.83 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $5.01 Median $5.25 Typical High $6.17 | Professional | UE · Used equipment | $5.01 | $5.25 | $6.17 |
Where New York sits
The same service costs 3.2 times more in Rhode Island 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.
New York· 51st of 51
$3.31
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.