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 $25.70 Median $25.70 Typical High $25.70 | Facility | None | $25.70 | $25.70 | $25.70 |
Aetna Setting Professional Modifier None Typical Low $25.70 Median $25.70 Typical High $93.33 | Professional | None | $25.70 | $25.70 | $93.33 |
Anthem BCBS Setting Facility Modifier None Typical Low $37.15 Median $40.74 Typical High $60.26 | Facility | None | $37.15 | $40.74 | $60.26 |
Anthem BCBS Setting Professional Modifier None Typical Low $33.88 Median $33.88 Typical High $41.69 | Professional | None | $33.88 | $33.88 | $41.69 |
Cigna Setting Facility Modifier None Typical Low $100.00 Median $114.82 Typical High $169.82 | Facility | None | $100.00 | $114.82 | $169.82 |
Cigna Setting Professional Modifier None Typical Low $15.14 Median $29.51 Typical High $61.66 | Professional | None | $15.14 | $29.51 | $61.66 |
DeanCare Setting Facility Modifier None Typical Low $20.89 Median $36.31 Typical High $38.02 | Facility | None | $20.89 | $36.31 | $38.02 |
DeanCare Setting Professional Modifier None Typical Low $33.11 Median $36.31 Typical High $39.81 | Professional | None | $33.11 | $36.31 | $39.81 |
Medica Setting Facility Modifier None Typical Low $20.89 Median $36.31 Typical High $72.44 | Facility | None | $20.89 | $36.31 | $72.44 |
Medica Setting Professional Modifier None Typical Low $16.60 Median $23.99 Typical High $302.00 | Professional | None | $16.60 | $23.99 | $302.00 |
Network Health Setting Professional Modifier None Typical Low $33.88 Median $47.86 Typical High $91.20 | Professional | None | $33.88 | $47.86 | $91.20 |
Prevea360 Setting Facility Modifier None Typical Low $20.89 Median $36.31 Typical High $38.02 | Facility | None | $20.89 | $36.31 | $38.02 |
Prevea360 Setting Professional Modifier None Typical Low $25.12 Median $36.31 Typical High $36.31 | Professional | None | $25.12 | $36.31 | $36.31 |
Quartz Setting Professional Modifier None Typical Low $35.48 Median $54.95 Typical High $81.28 | Professional | None | $35.48 | $54.95 | $81.28 |
Quartz Setting Professional Modifier None Typical Low $15.14 Median $15.14 Typical High $15.14 | Professional | None | $15.14 | $15.14 | $15.14 |
United Setting Professional Modifier None Typical Low $12.02 Median $18.20 Typical High $33.11 | Professional | None | $12.02 | $18.20 | $33.11 |
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 $12.88 Median $12.88 Typical High $46.77 | Professional | 52 · Reduced service | $12.88 | $12.88 | $46.77 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $5.25 Median $5.25 Typical High $18.62 | Professional | 53 · Discontinued | $5.25 | $5.25 | $18.62 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $19.50 Median $19.50 Typical High $70.79 | Professional | 54 · Surgery only | $19.50 | $19.50 | $70.79 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $3.89 Median $3.89 Typical High $14.13 | Professional | 55 · Aftercare only | $3.89 | $3.89 | $14.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.57 Median $2.57 Typical High $9.33 | Professional | 56 · Pre-op care only | $2.57 | $2.57 | $9.33 |
Where Wisconsin 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.
Wisconsin· 10th of 51
$33.88
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.