How much rates vary
Facilitymedian $17 · 10th to 90th $13 to $43Professionalmedian $14 · 10th to 90th $6 to $28
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 $10.96 Median $10.96 Typical High $10.96 | Facility | None | $10.96 | $10.96 | $10.96 |
Aetna Setting Professional Modifier None Typical Low $10.96 Median $10.96 Typical High $60.26 | Professional | None | $10.96 | $10.96 | $60.26 |
Anthem BCBS Setting Facility Modifier None Typical Low $15.49 Median $16.98 Typical High $25.70 | Facility | None | $15.49 | $16.98 | $25.70 |
Anthem BCBS Setting Professional Modifier None Typical Low $14.45 Median $14.45 Typical High $17.38 | Professional | None | $14.45 | $14.45 | $17.38 |
Cigna Setting Facility Modifier None Typical Low $42.66 Median $47.86 Typical High $72.44 | Facility | None | $42.66 | $47.86 | $72.44 |
Cigna Setting Professional Modifier None Typical Low $6.31 Median $12.30 Typical High $25.70 | Professional | None | $6.31 | $12.30 | $25.70 |
DeanCare Setting Facility Modifier None Typical Low $8.91 Median $15.14 Typical High $15.85 | Facility | None | $8.91 | $15.14 | $15.85 |
DeanCare Setting Professional Modifier None Typical Low $13.80 Median $85.11 Typical High $97.72 | Professional | None | $13.80 | $85.11 | $97.72 |
Medica Setting Facility Modifier None Typical Low $8.91 Median $15.14 Typical High $34.67 | Facility | None | $8.91 | $15.14 | $34.67 |
Medica Setting Professional Modifier None Typical Low $7.08 Median $10.00 Typical High $295.12 | Professional | None | $7.08 | $10.00 | $295.12 |
Network Health Setting Professional Modifier None Typical Low $14.13 Median $19.95 Typical High $38.02 | Professional | None | $14.13 | $19.95 | $38.02 |
Prevea360 Setting Facility Modifier None Typical Low $8.91 Median $15.14 Typical High $15.85 | Facility | None | $8.91 | $15.14 | $15.85 |
Prevea360 Setting Professional Modifier None Typical Low $15.14 Median $15.14 Typical High $24.55 | Professional | None | $15.14 | $15.14 | $24.55 |
Quartz Setting Professional Modifier None Typical Low $14.45 Median $23.44 Typical High $33.11 | Professional | None | $14.45 | $23.44 | $33.11 |
Quartz Setting Professional Modifier None Typical Low $6.31 Median $6.31 Typical High $6.31 | Professional | None | $6.31 | $6.31 | $6.31 |
Security Health Setting Professional Modifier None Typical Low $40.74 Median $40.74 Typical High $47.86 | Professional | None | $40.74 | $40.74 | $47.86 |
The Alliance Setting Professional Modifier None Typical Low $16.98 Median $23.99 Typical High $79.43 | Professional | None | $16.98 | $23.99 | $79.43 |
United Setting Professional Modifier None Typical Low $5.01 Median $7.59 Typical High $14.13 | Professional | None | $5.01 | $7.59 | $14.13 |
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 $5.50 Median $5.50 Typical High $30.20 | Professional | 52 · Reduced service | $5.50 | $5.50 | $30.20 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.19 Median $2.19 Typical High $12.02 | Professional | 53 · Discontinued | $2.19 | $2.19 | $12.02 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $8.13 Median $8.13 Typical High $44.67 | Professional | 54 · Surgery only | $8.13 | $8.13 | $44.67 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.62 Median $1.62 Typical High $8.91 | Professional | 55 · Aftercare only | $1.62 | $1.62 | $8.91 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.10 Median $1.10 Typical High $6.03 | Professional | 56 · Pre-op care only | $1.10 | $1.10 | $6.03 |
Where Wisconsin 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.
Wisconsin· 11th of 51
$14.45
RI $27.54NY $6.17
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.