How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). 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 $8.32 Median $8.32 Typical High $8.32 | Facility | None | $8.32 | $8.32 | $8.32 |
Aetna Setting Professional Modifier None Typical Low $7.08 Median $8.32 Typical High $43.65 | Professional | None | $7.08 | $8.32 | $43.65 |
Anthem BCBS Setting Facility Modifier None Typical Low $12.02 Median $13.18 Typical High $19.50 | Facility | None | $12.02 | $13.18 | $19.50 |
Anthem BCBS Setting Professional Modifier None Typical Low $10.96 Median $10.96 Typical High $13.18 | Professional | None | $10.96 | $10.96 | $13.18 |
Cigna Setting Facility Modifier None Typical Low $32.36 Median $37.15 Typical High $54.95 | Facility | None | $32.36 | $37.15 | $54.95 |
Cigna Setting Professional Modifier None Typical Low $4.90 Median $9.55 Typical High $19.95 | Professional | None | $4.90 | $9.55 | $19.95 |
DeanCare Setting Facility Modifier None Typical Low $6.76 Median $11.75 Typical High $12.30 | Facility | None | $6.76 | $11.75 | $12.30 |
DeanCare Setting Professional Modifier None Typical Low $10.72 Median $46.77 Typical High $53.70 | Professional | None | $10.72 | $46.77 | $53.70 |
Medica Setting Facility Modifier None Typical Low $6.76 Median $11.75 Typical High $23.44 | Facility | None | $6.76 | $11.75 | $23.44 |
Medica Setting Professional Modifier None Typical Low $5.37 Median $7.76 Typical High $138.04 | Professional | None | $5.37 | $7.76 | $138.04 |
Network Health Setting Professional Modifier None Typical Low $10.96 Median $15.49 Typical High $29.51 | Professional | None | $10.96 | $15.49 | $29.51 |
Prevea360 Setting Facility Modifier None Typical Low $6.76 Median $11.75 Typical High $12.30 | Facility | None | $6.76 | $11.75 | $12.30 |
Prevea360 Setting Professional Modifier None Typical Low $11.22 Median $11.75 Typical High $11.75 | Professional | None | $11.22 | $11.75 | $11.75 |
Quartz Setting Professional Modifier None Typical Low $11.48 Median $17.78 Typical High $26.30 | Professional | None | $11.48 | $17.78 | $26.30 |
Quartz Setting Professional Modifier None Typical Low $4.90 Median $4.90 Typical High $4.90 | Professional | None | $4.90 | $4.90 | $4.90 |
United Setting Professional Modifier None Typical Low $3.89 Median $5.75 Typical High $10.72 | Professional | None | $3.89 | $5.75 | $10.72 |
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 $4.17 Median $4.17 Typical High $21.88 | Professional | 52 · Reduced service | $4.17 | $4.17 | $21.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.70 Median $1.70 Typical High $8.71 | Professional | 53 · Discontinued | $1.70 | $1.70 | $8.71 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $6.31 Median $6.31 Typical High $33.11 | Professional | 54 · Surgery only | $6.31 | $6.31 | $33.11 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.26 Median $1.26 Typical High $6.61 | Professional | 55 · Aftercare only | $1.26 | $1.26 | $6.61 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.83 Median $0.83 Typical High $4.37 | Professional | 56 · Pre-op care only | $0.83 | $0.83 | $4.37 |
Where Wisconsin 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.
Wisconsin· 11th of 51
$10.96
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.