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 $83.18 Median $93.33 Typical High $154.88 | Facility | None | $83.18 | $93.33 | $154.88 |
Aetna Setting Professional Modifier None Typical Low $81.28 Median $89.13 Typical High $93.33 | Professional | None | $81.28 | $89.13 | $93.33 |
Anthem BCBS Setting Professional Modifier None Typical Low $60.26 Median $87.10 Typical High $100.00 | Professional | None | $60.26 | $87.10 | $100.00 |
CareSource Setting Facility Modifier None Typical Low $147.91 Median $147.91 Typical High $147.91 | Facility | None | $147.91 | $147.91 | $147.91 |
CareSource Setting Professional Modifier None Typical Low $158.49 Median $186.21 Typical High $234.42 | Professional | None | $158.49 | $186.21 | $234.42 |
Cigna Setting Facility Modifier None Typical Low $204.17 Median $204.17 Typical High $204.17 | Facility | None | $204.17 | $204.17 | $204.17 |
Cigna Setting Professional Modifier None Typical Low $61.66 Median $61.66 Typical High $724.44 | Professional | None | $61.66 | $61.66 | $724.44 |
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 $48.98 Median $64.57 Typical High $87.10 | Professional | None | $48.98 | $64.57 | $87.10 |
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 $40.74 Median $44.67 Typical High $46.77 | Professional | 52 · Reduced service | $40.74 | $44.67 | $46.77 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.22 Median $17.78 Typical High $19.05 | Professional | 53 · Discontinued | $16.22 | $17.78 | $19.05 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $60.26 Median $66.07 Typical High $70.79 | Professional | 54 · Surgery only | $60.26 | $66.07 | $70.79 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.02 Median $13.18 Typical High $14.13 | Professional | 55 · Aftercare only | $12.02 | $13.18 | $14.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.13 Median $8.91 Typical High $9.33 | Professional | 56 · Pre-op care only | $8.13 | $8.91 | $9.33 |
Where Kentucky sits
The same service costs 2.8 times more in Hawaii 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· 31st of 51
$87.10
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.