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 $5.01 Median $6.76 Typical High $7.94 | Facility | None | $5.01 | $6.76 | $7.94 |
Aetna Setting Professional Modifier None Typical Low $5.01 Median $5.01 Typical High $6.76 | Professional | None | $5.01 | $5.01 | $6.76 |
Anthem BCBS Setting Professional Modifier None Typical Low $2.29 Median $2.75 Typical High $3.24 | Professional | None | $2.29 | $2.75 | $3.24 |
CDPHP Setting Professional Modifier None Typical Low $6.03 Median $6.03 Typical High $6.03 | Professional | None | $6.03 | $6.03 | $6.03 |
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 $3.02 | Professional | None | $3.02 | $3.02 | $3.02 |
Emblem Health Setting Facility Modifier None Typical Low $7.41 Median $10.96 Typical High $26.30 | Facility | None | $7.41 | $10.96 | $26.30 |
Emblem Health Setting Professional Modifier None Typical Low $7.76 Median $8.91 Typical High $13.80 | Professional | None | $7.76 | $8.91 | $13.80 |
Excellus BCBS Setting Professional Modifier None Typical Low $6.03 Median $6.17 Typical High $6.61 | Professional | None | $6.03 | $6.17 | $6.61 |
MVP Health Care Setting Professional Modifier None Typical Low $8.51 Median $8.91 Typical High $10.72 | Professional | None | $8.51 | $8.91 | $10.72 |
United Setting Professional Modifier None Typical Low $2.40 Median $4.47 Typical High $5.37 | Professional | None | $2.40 | $4.47 | $5.37 |
Univera Setting Facility Modifier None Typical Low $6.17 Median $6.17 Typical High $6.17 | Facility | None | $6.17 | $6.17 | $6.17 |
Univera Setting Professional Modifier None Typical Low $3.39 Median $6.17 Typical High $6.61 | Professional | None | $3.39 | $6.17 | $6.61 |
7 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 $2.51 Median $2.51 Typical High $3.39 | Professional | 52 · Reduced service | $2.51 | $2.51 | $3.39 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.00 Median $1.00 Typical High $1.38 | Professional | 53 · Discontinued | $1.00 | $1.00 | $1.38 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $3.80 Median $3.80 Typical High $5.13 | Professional | 54 · Surgery only | $3.80 | $3.80 | $5.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.76 Median $0.76 Typical High $1.02 | Professional | 55 · Aftercare only | $0.76 | $0.76 | $1.02 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.50 Median $0.50 Typical High $0.68 | Professional | 56 · Pre-op care only | $0.50 | $0.50 | $0.68 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $0.60 Median $0.62 Typical High $0.74 | Professional | RR · Rental | $0.60 | $0.62 | $0.74 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $4.47 Median $5.25 Typical High $5.50 | Professional | UE · Used equipment | $4.47 | $5.25 | $5.50 |
Where New York 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.
New York· 51st of 51
$2.95
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.