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 Facility Modifier None Typical Low $4.07 Median $4.07 Typical High $4.07 | Facility | None | $4.07 | $4.07 | $4.07 |
Aetna Setting Professional Modifier None Typical Low $4.07 Median $4.07 Typical High $30.20 | Professional | None | $4.07 | $4.07 | $30.20 |
Anthem BCBS Setting Facility Modifier None Typical Low $5.75 Median $6.31 Typical High $9.55 | Facility | None | $5.75 | $6.31 | $9.55 |
Anthem BCBS Setting Professional Modifier None Typical Low $5.37 Median $5.37 Typical High $6.46 | Professional | None | $5.37 | $5.37 | $6.46 |
Cigna Setting Facility Modifier None Typical Low $16.22 Median $18.62 Typical High $27.54 | Facility | None | $16.22 | $18.62 | $27.54 |
Cigna Setting Professional Modifier None Typical Low $2.34 Median $4.68 Typical High $9.77 | Professional | None | $2.34 | $4.68 | $9.77 |
DeanCare Setting Facility Modifier None Typical Low $3.31 Median $5.75 Typical High $6.03 | Facility | None | $3.31 | $5.75 | $6.03 |
DeanCare Setting Professional Modifier None Typical Low $5.13 Median $37.15 Typical High $42.66 | Professional | None | $5.13 | $37.15 | $42.66 |
Medica Setting Facility Modifier None Typical Low $3.31 Median $5.75 Typical High $11.48 | Facility | None | $3.31 | $5.75 | $11.48 |
Medica Setting Professional Modifier None Typical Low $2.63 Median $3.80 Typical High $69.18 | Professional | None | $2.63 | $3.80 | $69.18 |
Network Health Setting Professional Modifier None Typical Low $5.37 Median $7.59 Typical High $14.13 | Professional | None | $5.37 | $7.59 | $14.13 |
Prevea360 Setting Facility Modifier None Typical Low $3.31 Median $5.75 Typical High $6.03 | Facility | None | $3.31 | $5.75 | $6.03 |
Prevea360 Setting Professional Modifier None Typical Low $5.62 Median $5.75 Typical High $5.75 | Professional | None | $5.62 | $5.75 | $5.75 |
Quartz Setting Professional Modifier None Typical Low $5.62 Median $8.71 Typical High $12.88 | Professional | None | $5.62 | $8.71 | $12.88 |
Quartz Setting Professional Modifier None Typical Low $2.34 Median $2.34 Typical High $2.34 | Professional | None | $2.34 | $2.34 | $2.34 |
Security Health Setting Professional Modifier None Typical Low $9.55 Median $9.55 Typical High $11.22 | Professional | None | $9.55 | $9.55 | $11.22 |
United Setting Professional Modifier None Typical Low $1.91 Median $2.82 Typical High $5.25 | Professional | None | $1.91 | $2.82 | $5.25 |
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 $2.04 Median $2.04 Typical High $15.14 | Professional | 52 · Reduced service | $2.04 | $2.04 | $15.14 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.81 Median $0.81 Typical High $6.03 | Professional | 53 · Discontinued | $0.81 | $0.81 | $6.03 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $3.09 Median $3.09 Typical High $22.39 | Professional | 54 · Surgery only | $3.09 | $3.09 | $22.39 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.62 Median $0.62 Typical High $4.47 | Professional | 55 · Aftercare only | $0.62 | $0.62 | $4.47 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.41 Median $0.41 Typical High $3.02 | Professional | 56 · Pre-op care only | $0.41 | $0.41 | $3.02 |
Where Wisconsin sits
The same service costs 3.0 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.
Wisconsin· 10th of 51
$5.37
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.