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 $8.51 Median $8.51 Typical High $8.51 | Facility | None | $8.51 | $8.51 | $8.51 |
Aetna Setting Professional Modifier None Typical Low $6.76 Median $8.32 Typical High $8.51 | Professional | None | $6.76 | $8.32 | $8.51 |
BCBS New Mexico Setting Professional Modifier None Typical Low $7.08 Median $9.33 Typical High $9.33 | Professional | None | $7.08 | $9.33 | $9.33 |
Cigna Setting Professional Modifier None Typical Low $4.90 Median $4.90 Typical High $4.90 | Professional | None | $4.90 | $4.90 | $4.90 |
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 $14.45 Median $14.45 Typical High $28.18 | Facility | None | $14.45 | $14.45 | $28.18 |
Providence Setting Professional Modifier None Typical Low $4.90 Median $4.90 Typical High $12.88 | Professional | None | $4.90 | $4.90 | $12.88 |
United Setting Professional Modifier None Typical Low $4.90 Median $4.90 Typical High $8.51 | Professional | None | $4.90 | $4.90 | $8.51 |
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 $3.80 Median $4.17 Typical High $4.27 | Professional | 52 · Reduced service | $3.80 | $4.17 | $4.27 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.51 Median $1.66 Typical High $1.70 | Professional | 53 · Discontinued | $1.51 | $1.66 | $1.70 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $5.75 Median $6.17 Typical High $6.31 | Professional | 54 · Surgery only | $5.75 | $6.17 | $6.31 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.15 Median $1.23 Typical High $1.26 | Professional | 55 · Aftercare only | $1.15 | $1.23 | $1.26 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.78 Median $0.83 Typical High $0.85 | Professional | 56 · Pre-op care only | $0.78 | $0.83 | $0.85 |
Where New Mexico sits
The same service costs 2.9 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· 32nd of 51
$6.76
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.