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 $3.02 Median $3.47 Typical High $9.77 | Facility | None | $3.02 | $3.47 | $9.77 |
Aetna Setting Professional Modifier None Typical Low $2.95 Median $3.39 Typical High $4.27 | Professional | None | $2.95 | $3.39 | $4.27 |
Anthem BCBS Setting Professional Modifier None Typical Low $2.24 Median $3.24 Typical High $3.63 | Professional | None | $2.24 | $3.24 | $3.63 |
CareSource Setting Facility Modifier None Typical Low $5.37 Median $5.37 Typical High $5.37 | Facility | None | $5.37 | $5.37 | $5.37 |
CareSource Setting Professional Modifier None Typical Low $5.75 Median $6.76 Typical High $8.71 | Professional | None | $5.75 | $6.76 | $8.71 |
Cigna Setting Facility Modifier None Typical Low $7.41 Median $7.41 Typical High $7.41 | Facility | None | $7.41 | $7.41 | $7.41 |
Cigna Setting Professional Modifier None Typical Low $2.24 Median $2.24 Typical High $32.36 | Professional | None | $2.24 | $2.24 | $32.36 |
Molina Setting Professional Modifier None Typical Low $44.67 Median $44.67 Typical High $44.67 | Professional | None | $44.67 | $44.67 | $44.67 |
United Setting Professional Modifier None Typical Low $1.78 Median $2.34 Typical High $3.16 | Professional | None | $1.78 | $2.34 | $3.16 |
5 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 $1.48 Median $1.66 Typical High $1.74 | Professional | 52 · Reduced service | $1.48 | $1.66 | $1.74 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.59 Median $0.66 Typical High $0.69 | Professional | 53 · Discontinued | $0.59 | $0.66 | $0.69 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2.24 Median $2.45 Typical High $2.57 | Professional | 54 · Surgery only | $2.24 | $2.45 | $2.57 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.44 Median $0.50 Typical High $0.52 | Professional | 55 · Aftercare only | $0.44 | $0.50 | $0.52 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.30 Median $0.33 Typical High $0.35 | Professional | 56 · Pre-op care only | $0.30 | $0.33 | $0.35 |
Where Kentucky sits
The same service costs 3.8 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.
Kentucky· 35th of 51
$3.24
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.