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 $14.45 Median $16.60 Typical High $43.65 | Facility | None | $14.45 | $16.60 | $43.65 |
Aetna Setting Professional Modifier None Typical Low $14.13 Median $16.22 Typical High $19.05 | Professional | None | $14.13 | $16.22 | $19.05 |
Ambetter Setting Professional Modifier None Typical Low $15.85 Median $15.85 Typical High $15.85 | Professional | None | $15.85 | $15.85 | $15.85 |
Anthem BCBS Setting Professional Modifier None Typical Low $10.72 Median $15.14 Typical High $17.38 | Professional | None | $10.72 | $15.14 | $17.38 |
CareSource Setting Facility Modifier None Typical Low $25.70 Median $25.70 Typical High $25.70 | Facility | None | $25.70 | $25.70 | $25.70 |
CareSource Setting Professional Modifier None Typical Low $27.54 Median $32.36 Typical High $40.74 | Professional | None | $27.54 | $32.36 | $40.74 |
Cigna Setting Facility Modifier None Typical Low $35.48 Median $35.48 Typical High $35.48 | Facility | None | $35.48 | $35.48 | $35.48 |
Cigna Setting Professional Modifier None Typical Low $10.72 Median $10.72 Typical High $144.54 | Professional | None | $10.72 | $10.72 | $144.54 |
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 $8.51 Median $11.22 Typical High $15.14 | Professional | None | $8.51 | $11.22 | $15.14 |
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 $7.08 Median $7.94 Typical High $8.32 | Professional | 52 · Reduced service | $7.08 | $7.94 | $8.32 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.82 Median $3.16 Typical High $3.31 | Professional | 53 · Discontinued | $2.82 | $3.16 | $3.31 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $10.72 Median $11.75 Typical High $12.30 | Professional | 54 · Surgery only | $10.72 | $11.75 | $12.30 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.14 Median $2.34 Typical High $2.45 | Professional | 55 · Aftercare only | $2.14 | $2.34 | $2.45 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.41 Median $1.58 Typical High $1.66 | Professional | 56 · Pre-op care only | $1.41 | $1.58 | $1.66 |
Where Kentucky sits
The same service costs 3.5 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.
Kentucky· 36th of 51
$15.14
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.