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 $10.00 Median $11.48 Typical High $17.78 | Facility | None | $10.00 | $11.48 | $17.78 |
Aetna Setting Professional Modifier None Typical Low $10.00 Median $10.72 Typical High $11.48 | Professional | None | $10.00 | $10.72 | $11.48 |
Anthem BCBS Setting Professional Modifier None Typical Low $7.41 Median $10.72 Typical High $12.30 | Professional | None | $7.41 | $10.72 | $12.30 |
CareSource Setting Facility Modifier None Typical Low $18.20 Median $18.20 Typical High $18.20 | Facility | None | $18.20 | $18.20 | $18.20 |
CareSource Setting Professional Modifier None Typical Low $19.50 Median $22.39 Typical High $28.84 | Professional | None | $19.50 | $22.39 | $28.84 |
Cigna Setting Facility Modifier None Typical Low $25.12 Median $25.12 Typical High $25.12 | Facility | None | $25.12 | $25.12 | $25.12 |
Cigna Setting Professional Modifier None Typical Low $7.59 Median $7.59 Typical High $89.13 | Professional | None | $7.59 | $7.59 | $89.13 |
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 $6.03 Median $7.94 Typical High $10.47 | Professional | None | $6.03 | $7.94 | $10.47 |
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 $5.01 Median $5.37 Typical High $5.75 | Professional | 52 · Reduced service | $5.01 | $5.37 | $5.75 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.00 Median $2.14 Typical High $2.29 | Professional | 53 · Discontinued | $2.00 | $2.14 | $2.29 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $7.41 Median $8.13 Typical High $8.71 | Professional | 54 · Surgery only | $7.41 | $8.13 | $8.71 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.48 Median $1.62 Typical High $1.74 | Professional | 55 · Aftercare only | $1.48 | $1.62 | $1.74 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.00 Median $1.07 Typical High $1.15 | Professional | 56 · Pre-op care only | $1.00 | $1.07 | $1.15 |
Where Kentucky sits
The same service costs 2.7 times more in Idaho 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· 30th of 51
$10.72
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.