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 $4.07 Median $4.57 Typical High $7.59 | Facility | None | $4.07 | $4.57 | $7.59 |
Aetna Setting Professional Modifier None Typical Low $3.98 Median $4.37 Typical High $4.57 | Professional | None | $3.98 | $4.37 | $4.57 |
Anthem BCBS Setting Professional Modifier None Typical Low $2.95 Median $4.27 Typical High $4.90 | Professional | None | $2.95 | $4.27 | $4.90 |
CareSource Setting Facility Modifier None Typical Low $7.24 Median $7.24 Typical High $7.24 | Facility | None | $7.24 | $7.24 | $7.24 |
CareSource Setting Professional Modifier None Typical Low $7.76 Median $9.12 Typical High $11.48 | Professional | None | $7.76 | $9.12 | $11.48 |
Cigna Setting Facility Modifier None Typical Low $10.00 Median $10.00 Typical High $10.00 | Facility | None | $10.00 | $10.00 | $10.00 |
Cigna Setting Professional Modifier None Typical Low $3.02 Median $3.02 Typical High $35.48 | Professional | None | $3.02 | $3.02 | $35.48 |
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 $2.40 Median $3.16 Typical High $4.27 | Professional | None | $2.40 | $3.16 | $4.27 |
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 $2.00 Median $2.19 Typical High $2.29 | Professional | 52 · Reduced service | $2.00 | $2.19 | $2.29 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.79 Median $0.87 Typical High $0.91 | Professional | 53 · Discontinued | $0.79 | $0.87 | $0.91 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2.95 Median $3.24 Typical High $3.47 | Professional | 54 · Surgery only | $2.95 | $3.24 | $3.47 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.60 Median $0.65 Typical High $0.69 | Professional | 55 · Aftercare only | $0.60 | $0.65 | $0.69 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.40 Median $0.43 Typical High $0.46 | Professional | 56 · Pre-op care only | $0.40 | $0.43 | $0.46 |
Where Kentucky sits
The same service costs 2.7 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.
Kentucky· 31st of 51
$4.27
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.