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 $8.51 Median $9.77 Typical High $34.67 | Facility | None | $8.51 | $9.77 | $34.67 |
Aetna Setting Professional Modifier None Typical Low $8.32 Median $9.55 Typical High $14.79 | Professional | None | $8.32 | $9.55 | $14.79 |
Ambetter Setting Professional Modifier None Typical Low $9.77 Median $9.77 Typical High $13.80 | Professional | None | $9.77 | $9.77 | $13.80 |
Anthem BCBS Setting Professional Modifier None Typical Low $6.31 Median $8.91 Typical High $10.23 | Professional | None | $6.31 | $8.91 | $10.23 |
CareSource Setting Facility Modifier None Typical Low $15.14 Median $17.78 Typical High $21.38 | Facility | None | $15.14 | $17.78 | $21.38 |
CareSource Setting Professional Modifier None Typical Low $15.14 Median $16.22 Typical High $21.38 | Professional | None | $15.14 | $16.22 | $21.38 |
Cigna Setting Facility Modifier None Typical Low $20.89 Median $20.89 Typical High $20.89 | Facility | None | $20.89 | $20.89 | $20.89 |
Cigna Setting Professional Modifier None Typical Low $6.31 Median $6.31 Typical High $114.82 | Professional | None | $6.31 | $6.31 | $114.82 |
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 $5.01 Median $6.61 Typical High $8.91 | Professional | None | $5.01 | $6.61 | $8.91 |
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 $4.17 Median $4.68 Typical High $4.90 | Professional | 52 · Reduced service | $4.17 | $4.68 | $4.90 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.66 Median $1.86 Typical High $1.95 | Professional | 53 · Discontinued | $1.66 | $1.86 | $1.95 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $6.31 Median $6.92 Typical High $7.24 | Professional | 54 · Surgery only | $6.31 | $6.92 | $7.24 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.26 Median $1.41 Typical High $1.45 | Professional | 55 · Aftercare only | $1.26 | $1.41 | $1.45 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.83 Median $0.91 Typical High $0.98 | Professional | 56 · Pre-op care only | $0.83 | $0.91 | $0.98 |
Where Kentucky sits
The same service costs 4.5 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· 36th of 51
$8.91
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.