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 $18.62 Median $18.62 Typical High $18.62 | Facility | None | $18.62 | $18.62 | $18.62 |
Aetna Setting Professional Modifier None Typical Low $16.98 Median $18.20 Typical High $18.62 | Professional | None | $16.98 | $18.20 | $18.62 |
BCBS New Mexico Setting Professional Modifier None Typical Low $15.49 Median $20.42 Typical High $20.42 | Professional | None | $15.49 | $20.42 | $20.42 |
Cigna Setting Professional Modifier None Typical Low $10.72 Median $10.72 Typical High $10.72 | Professional | None | $10.72 | $10.72 | $10.72 |
Molina Setting Professional Modifier None Typical Low $60.26 Median $60.26 Typical High $60.26 | Professional | None | $60.26 | $60.26 | $60.26 |
Providence Setting Facility Modifier None Typical Low $38.90 Median $38.90 Typical High $75.86 | Facility | None | $38.90 | $38.90 | $75.86 |
Providence Setting Professional Modifier None Typical Low $10.72 Median $10.72 Typical High $28.18 | Professional | None | $10.72 | $10.72 | $28.18 |
United Setting Professional Modifier None Typical Low $10.96 Median $10.96 Typical High $18.62 | Professional | None | $10.96 | $10.96 | $18.62 |
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 $8.51 Median $9.12 Typical High $9.33 | Professional | 52 · Reduced service | $8.51 | $9.12 | $9.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $3.39 Median $3.63 Typical High $3.72 | Professional | 53 · Discontinued | $3.39 | $3.63 | $3.72 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $12.59 Median $13.80 Typical High $14.13 | Professional | 54 · Surgery only | $12.59 | $13.80 | $14.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.51 Median $2.75 Typical High $2.82 | Professional | 55 · Aftercare only | $2.51 | $2.75 | $2.82 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.70 Median $1.82 Typical High $1.86 | Professional | 56 · Pre-op care only | $1.70 | $1.82 | $1.86 |
Where New Mexico 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.
New Mexico· 34th of 51
$15.49
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.