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 $60.26 Median $60.26 Typical High $60.26 | Facility | None | $60.26 | $60.26 | $60.26 |
Aetna Setting Professional Modifier None Typical Low $46.77 Median $58.88 Typical High $60.26 | Professional | None | $46.77 | $58.88 | $60.26 |
BCBS New Mexico Setting Professional Modifier None Typical Low $50.12 Median $67.61 Typical High $67.61 | Professional | None | $50.12 | $67.61 | $67.61 |
Cigna Setting Professional Modifier None Typical Low $34.67 Median $34.67 Typical High $34.67 | Professional | None | $34.67 | $34.67 | $34.67 |
Molina Setting Professional Modifier None Typical Low $33.11 Median $33.11 Typical High $33.11 | Professional | None | $33.11 | $33.11 | $33.11 |
Providence Setting Facility Modifier None Typical Low $58.88 Median $58.88 Typical High $112.20 | Facility | None | $58.88 | $58.88 | $112.20 |
Providence Setting Professional Modifier None Typical Low $34.67 Median $34.67 Typical High $91.20 | Professional | None | $34.67 | $34.67 | $91.20 |
United Setting Professional Modifier None Typical Low $35.48 Median $35.48 Typical High $60.26 | Professional | None | $35.48 | $35.48 | $60.26 |
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 $25.12 Median $29.51 Typical High $30.20 | Professional | 52 · Reduced service | $25.12 | $29.51 | $30.20 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $10.00 Median $11.75 Typical High $12.30 | Professional | 53 · Discontinued | $10.00 | $11.75 | $12.30 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $38.02 Median $44.67 Typical High $45.71 | Professional | 54 · Surgery only | $38.02 | $44.67 | $45.71 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.59 Median $8.91 Typical High $9.12 | Professional | 55 · Aftercare only | $7.59 | $8.91 | $9.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.01 Median $5.89 Typical High $6.03 | Professional | 56 · Pre-op care only | $5.01 | $5.89 | $6.03 |
Where New Mexico 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.
New Mexico· 31st of 51
$50.12
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.