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 $2.69 Median $2.69 Typical High $3.55 | Facility | None | $2.69 | $2.69 | $3.55 |
Aetna Setting Professional Modifier None Typical Low $2.69 Median $2.69 Typical High $7.08 | Professional | None | $2.69 | $2.69 | $7.08 |
Anthem BCBS Setting Professional Modifier None Typical Low $3.39 Median $4.27 Typical High $19.50 | Professional | None | $3.39 | $4.27 | $19.50 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $0.31 Median $0.43 Typical High $1.95 | Professional | RR · Rental | $0.31 | $0.43 | $1.95 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $2.40 Median $3.24 Typical High $14.79 | Professional | UE · Used equipment | $2.40 | $3.24 | $14.79 |
Cigna Setting Professional Modifier None Typical Low $1.78 Median $1.78 Typical High $5.75 | Professional | None | $1.78 | $1.78 | $5.75 |
Kaiser Permanente Setting Professional Modifier None Typical Low $4.27 Median $4.27 Typical High $29.51 | Professional | None | $4.27 | $4.27 | $29.51 |
Oscar Health Setting Professional Modifier None Typical Low $4.90 Median $5.75 Typical High $6.03 | Professional | None | $4.90 | $5.75 | $6.03 |
United Setting Professional Modifier None Typical Low $1.41 Median $2.09 Typical High $7.76 | Professional | None | $1.41 | $2.09 | $7.76 |
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 $1.32 Median $1.35 Typical High $1.58 | Professional | 52 · Reduced service | $1.32 | $1.35 | $1.58 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.52 Median $0.54 Typical High $0.62 | Professional | 53 · Discontinued | $0.52 | $0.54 | $0.62 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1.95 Median $2.04 Typical High $2.34 | Professional | 54 · Surgery only | $1.95 | $2.04 | $2.34 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.39 Median $0.41 Typical High $0.47 | Professional | 55 · Aftercare only | $0.39 | $0.41 | $0.47 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.26 Median $0.27 Typical High $0.32 | Professional | 56 · Pre-op care only | $0.26 | $0.27 | $0.32 |
Where Georgia sits
The same service costs 4.0 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.
Georgia· 5th of 51
$4.27
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.